Brief Infant-Toddler Social And Emotional Assessment Research Articles

The Impact of Cerebral Visual Impairment on Social Skills and Sensory Processing.

Limited evidence exists on the impact of cerebral visual impairment (CVI) on developmental domains in toddlers. This study investigated whether CVI influences social skills and sensory processing in toddlers with cerebral palsy (CP). The study included toddlers with CP, with or without CVI, and typically developing (TD) toddlers. All parents completed the demographic information form. Social skills were assessed by the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Sensory processing was evaluated by the Infant/Toddler Sensory Profile (ITSP). Analysis of covariance was employed to assess the disparity in BITSEA and ITSP scores. Toddlers with CP and CVI group demonstrated lower social competence than the other groups (p < .05). Having CVI did not cause a statistically significant difference in sensory processing among toddlers with CP (p > .05). CVI significantly affects social competence in toddlers with CP but does not affect sensory processing.

Social-emotional and behavioural problems in young children of healthcare worker mothers during the COVID-19 outbreak: a case-control study

BackgroundThe pandemic has had a significant impact on the daily lives of children and their families, particularly the children of health care workers, due to changes in family routines as a result of their parents’ work schedules. We aimed to explore the socioemotional and behavioural (SEB) problems of children of healthcare worker mothers (HCWM) during the COVID-19 pandemic and compare them with age-matched children and their mothers from other occupations.MethodA case-control study design was applied, and a snowball approach was used to enrol volunteered participants aged between 6 and 36 months of age, through a Google survey. We used the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) questionnaire to assess children’s SEB problems and a Brief Symptom Inventory (BSI) to evaluate the psychological distress of mothers. Differences in BITSEA, BSI and MSPSS scores were examined using chi-square and Mann-Whitney U tests, as appropriate. A logistic regression model was used to identify independent predictors of children’s behavioural and emotional problems.ResultsIn total, 600 questionnaires were analysed. It was observed that children in the HCWM group were separated from their mothers more often and for longer periods of time than their counterparts (p < 0.010, p = 0.002). Changes in the child’s structured outdoor activities during the pandemic period were more likely to be observed in the HCWM group (p < 0.05). The percentage of children with the BITSEA problem subscale above the subclinical cut-off, externalizing and dysregulation scores were significantly higher in the HCWM group (p = 0.044, p = 0.031, and p = 0.016). Moreover, each point increase in BSI global index scores (p < 0.001, RR:3.34, 95%CI:1.91–5.82) was found as a risk factor for clinically significant SEB problems.ConclusionOverall, the current study suggests HCWM’s have experienced occupational inequality, and young children of HCWM’s were at increased risk for externalizing and dysregulation problems during the pandemic. Maternal psychological stress had a significant impact on their children’s socio-emotional well-being.

Computerized adaptive testing to screen pre-school children for emotional and behavioral problems.

Questionnaires to detect emotional and behavioral (EB) problems in preventive child healthcare (PCH) should be short; this potentially affects their validity and reliability. Computerized adaptive testing (CAT) could overcome this weakness. The aim of this study was to (1) develop a CAT to measure EB problems among pre-school children and (2) assess the efficiency and validity of this CAT. We used a Dutch national dataset obtained from parents of pre-school children undergoing a well-child care assessment by PCH (n = 2192, response 70%). Data regarded 197 items on EB problems, based on four questionnaires, the Strengths and Difficulties Questionnaire (SDQ), the Child Behavior Checklist (CBCL), the Ages and Stages Questionnaire: Social Emotional (ASQ:SE), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Using 80% of the sample, we calculated item parameters necessary for a CAT and defined a cutoff for EB problems. With the remaining part of the sample, we used simulation techniques to determine the validity and efficiency of this CAT, using as criterion a total clinical score on the CBCL. Item criteria were met by 193 items. This CAT needed, on average, 16 items to identify children with EB problems. Sensitivity and specificity compared to a clinical score on the CBCL were 0.89 and 0.91, respectively, for total problems; 0.80 and 0.93 for emotional problems; and 0.94 and 0.91 for behavioral problems. Conclusion: A CAT is very promising for the identification of EB problems in pre-school children, as it seems to yield an efficient, yet high-quality identification. This conclusion should be confirmed by real-life administration of this CAT. What is Known: • Studies indicate the validity of using computerized adaptive test (CAT) applications to identify emotional and behavioral problems in school-aged children. • Evidence is as yet limited on whether CAT applications can also be used with pre-school children. What is New: • The results of this study show that a computerized adaptive test is very promising for the identification of emotional and behavior problems in pre-school children, as it appears to yield an efficient and high-quality identification.

Bedtime routines, development, and caregiver educational attainment in toddlerhood

BackgroundImplementing a consistent bedtime routine is an empirically supported intervention to improve sleep in toddlers, but little is known about its association with social-emotional outcomes, and among children living in lower socioeconomic status (SES) contexts.ObjectiveThis study examined the longitudinal associations between bedtime routines, social-emotional development, and caregiver educational attainment in toddlers presenting to primary care.MethodCaregivers of 40 toddlers (Mage = 12.85 months, 57.5% female, 62.5% Black/African American) completed questionnaires on sociodemographic factors and child bedtime routine consistency at their 12-month well visit. At the 15- and 24-month well visits, data were collected on child bedtime routine consistency and social-emotional development, including the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) for social-emotional problems and competency and the Ages and Stages Questionnaire (3rd edition; ASQ-3) to assess communication and personal-social skills.ResultsOverall, the majority of families engaged in a consistent bedtime routine (≥5 nights/week) at all time points (63% at 12 months, 75% at 15 months, and 86% at 24 months). Controlling for concurrent bedtime routine consistency, toddlers with a more consistent bedtime routine at 12 months exhibited less dysregulation at age 15 months. Toddlers without a consistent bedtime routine at 15 months exhibited more externalizing and internalizing problems and dysregulation at 24 months. Furthermore, there was a significant interaction between bedtime routine consistency at 15 months and caregiver education for internalizing problems at 24 months, such that toddlers of caregivers with a high school education or less who lacked a consistent bedtime routine showed the most internalizing problems.ConclusionClinicians should consider recommending that families with toddlers incorporate a nightly bedtime routine not only to improve overall sleep health, but also to potentially optimize toddlers' positive social-emotional and behavioral trajectories, especially in families with lower educational attainment.

0781 Relationship between Bedtime Routines with Sleep, Development, and Parenting Stress in Toddlers

Abstract Introduction Institution of a nightly bedtime routine is a key component of sleep health and is likely to foster positive early childhood development. The current study investigated the longitudinal and concurrent relationships between a bedtime routine and sleep, social-emotional development, and parenting stress in toddlers living in lower income homes and/or neighborhoods. Methods Caregivers of 78 toddlers (56.4% female; M=12.87 mos; 67.9% Black; 73.1% WIC) reported on their child’s bedtime routine at their 12-month well-child visit. At their child’s 15- and 24-month well visit, caregivers completed the Brief Infant Sleep Questionnaire–Revised (BISQ-R SF), the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Parenting Stress Index (PSI-SF). Results were considered significant at p&amp;lt;.05. Results Toddlers with a consistent bedtime routine (5+ nights per week) at 12 months had significantly earlier bedtimes (20:54 vs 21:24) and waketimes (7:21 vs 8:48) at 24 months compared to those without a consistent routine. At 15 months, a more frequent bedtime routine was associated with fewer concurrent social-emotional problems (r = -.32) and decreased bedtime difficulty (r = -.34). At 24 months, toddlers with a consistent bedtime routine (33.3%) were less likely to exhibit concurrent BITSEA social-emotional competency concerns (66.7%). Caregivers also reported better nighttime sleep in toddlers with a consistent routine at 24 months. Additionally, caregivers whose child had a consistent routine at 15 and 24 months perceived their child as less difficult (PSI) at 24 months. However, no associations emerged between bedtime routine frequency and consistency at 12, 15, and 24 months with ASQ communication and personal-social concerns. Conclusion Bedtime routine frequency and consistency in toddlers was associated with better caregiver-perceived sleep, social-emotional development, and lower parental stress regarding their child being perceived as difficult, but not communication and personal-social concerns. A bedtime routine may be a cost-effective strategy to promote toddlers’ sleep, overall development, and family’s functioning. Support (if any) This study was partially funded by the Simms/Mann Institute

Polygenic risk for neuroticism is associated with externalizing symptoms in 2-year-old boys

Recent advances in genome-wide association studies have enabled the estimation of genetic risk of complex traits, including neuroticism, with polygenic risk scores (PRS). Neuroticism PRS has been associated with psychiatric disorders and symptoms in adults, but studies in children are scarce. We studied whether neuroticism PRS, and its subscales, worry PRS and depressive affect PRS, were associated with externalizing and internalizing symptoms in 2-year-olds. We also examined parental neuroticism PRSs' association with children's externalizing and internalizing symptoms and whether parental depressive symptoms mediated the effect. Participants from two Finnish birth cohorts, CHILD-SLEEP and FinnBrain Birth Cohort Study, who had DNA and data on Brief Infant-Toddler Social and Emotional Assessment (BITSEA) available were included in the study (N = 806 and N = 987, respectively). PRSs were calculated based on GWAS data from UK Biobank. Child's neuroticism PRS, and its subscale worry PRS, were positively associated with externalizing symptoms in 2-year-old boys, but not in girls. Mother's depressive symptoms mediated the association between maternal neuroticism PRS and externalizing and internalizing symptoms in boys, but not in girls. Our results suggest that neuroticism PRS, and its subscale worry PRS, are associated with externalizing symptoms in already as young as 2-year-old boys, and, that subclinical symptoms of maternal depression that are based on genetic disposition, have an effect on boy's internalizing and externalizing symptoms. As we did not find any associations in girls, our study supports the suggestion that girls and boys may differ in how genetic and environmental factors contribute to their development.

0512 Concurrent and longitudinal linkages between bedtime routines and social-emotional development in toddlers

Abstract Introduction Sleep is important for optimal development in early childhood. Instituting a consistent bedtime routine is an empirically supported behavioral intervention to promote early childhood sleep health. However, prior work has focused on the benefits of a bedtime routine for sleep outcomes, with little research on its potential benefits to social-emotional development. Thus, the current study examined concurrent and longitudinal associations between a consistent bedtime routine (defined as 5 or more nights per week) and social-emotional development in toddlers (ages 12.0 to 19.9 months). Methods Caregivers of 32 infants (M = 12.5mos, 59.4% female) completed baseline questionnaires about the frequency of their child’s bedtime routine and other evening activities at their scheduled 12-month well-child visit. At their child’s 15-month well visit, caregivers completed questionnaires including items on bedtime routine frequency, the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Results Over half (59.4%) of caregivers reported a consistent child bedtime routine at 12 months and nearly three quarters (71.9%) reported a consistent bedtime routine at 15 months. Linear regression showed that having a consistent bedtime routine at 15 months was significantly associated with fewer concurrent social-emotional problems on the BITSEA, B = -2.40, p = .009, 95% CI [-3.86, -.94]. Toddlers who scored above the BITSEA cutoff for social-emotional concerns (31.3%) were engaged in a consistent bedtime routine less frequently (M = 4.50 nights/week) than those below the cutoff (M = 6.18 nights/week), p = .004, η2 = .24. However, bedtime routine frequency at 12 months did not predict 15-month BITSEA concerns, p&amp;gt;.05. No associations emerged between bedtime routine frequency at 12 or 15 months and the communication and personal-social ASQ scores. Conclusion A consistent bedtime routine is concurrently, but not longitudinally, associated with positive social-emotional development, including less frequent clinically significant concerns, in toddlers at 15 months of age. Bedtime routine frequency was not linked to communication or personal-social interactions. Implementing a consistent bedtime routine may be a feasible method to promote toddlers’ social-emotional development within the context of concerns. Support (If Any) This study was partially funded by the Simms/Mann Institute

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

Study protocol: childhood outcomes of fetal genomic variants: the PrenatAL Microarray (PALM) cohort study

BackgroundThe implementation of genomic testing in pregnancy means that couples have access to more information about their child’s genetic make-up before birth than ever before. One of the resulting challenges is the management of genetic variations with unclear clinical significance. This population-based study will help to close this critical knowledge gap through a multidisciplinary cohort study of children with and without genomic copy number variants (CNVs) diagnosed before birth. By comparing children with prenatally-ascertained CNVs to children without a CNV, we aim to (1) examine their developmental, social-emotional and health status; (2) measure the impact of prenatal diagnosis of a CNV on maternal perceptions of child health, behavior and development; and (3) determine the proportion of prenatally-ascertained CNVs of unknown or uncertain significance that are reclassified as benign or pathogenic after 2 or more years.MethodsThis study will establish and follow up a cohort of mother-child pairs who have had a prenatal diagnosis with a chromosomal microarray from 2013-2019 in the Australian state of Victoria. Children aged 12 months to 7 years will be assessed using validated, age-appropriate measures. The primary outcome measures will be the Wechsler Preschool and Primary Scale of Intelligence IV (WPSSI-IV) IQ score (2.5 to 7 year old’s), the Ages and Stages Questionnaire (12-30 months old), and the Brief Infant- Toddler Social and Emotional Assessment (BITSEA) score. Clinical assessment by a pediatrician will also be performed. Secondary outcomes will be scores obtained from the: Vineland Adaptive Behavior Scale, Maternal Postnatal Attachment Questionnaire, the Vulnerable Child Scale, Profile of Mood States, Parent Sense of Competence Scale. A descriptive analysis of the reclassification rates of CNVs after ≥2 years will be performed.DiscussionThis study protocol describes the first Australian cohort study following children after prenatal diagnostic testing with chromosomal microarray. It will provide long-term outcomes of fetal genomic variants to guide evidence-based pre-and postnatal care. This, in turn, will inform future efforts to mitigate the negative consequences of conveying genomic uncertainty during pregnancy.Trial registrationACTRN12620000446965p; Registered on April 6, 2020.

Signaled night awakening and its association with social information processing and socio-emotional development across the first two years.

Study ObjectivesNight awakening is common in infancy, and some infants continue to have signaled night awakenings throughout early childhood. However, the influence of signaled night awakening on children’s social development is less explored. In the present study, longitudinal associations between signaled night awakening, social information processing, and socio-emotional development were measured within the CHILD-SLEEP birth cohort in two groups formed based on parent-reported night awakenings.MethodsAt 8 months, there were 77 infants in the waking group (≥3 awakenings) and 69 infants in the nonwaking group (≤1 awakening). At 8 and 24 months, social information processing was measured as children’s attention to neutral and emotional faces, and at 24 months, parent-reported socio-emotional behavior was measured with the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) questionnaire.ResultsThe two groups showed different patterns of attention to emotional faces. The waking group had a more pronounced attentional bias to fearful versus happy faces, whereas in the nonwaking group, attention to fearful and happy faces did not differ. In addition, at 24 months, the waking group had more dysregulation problems and lower social competence than the nonwaking group, but no clear differences in internalizing or externalizing problems were found.ConclusionsOur results contribute to the literature by showing that during the first 2 years of life, signaled night awakening is associated with social information processing and socio-emotional behavior.

Communication skills predict social-emotional competencies

IntroductionStudies have shown that many children with early language difficulties also have delays in social-emotional competencies as well as social-emotional and behavioral problems. It is unclear if these conditions are causally related, if they share a common underlying etiology, or if there are bidirectional effects. Studies investigating these associations have mostly involved children who are already using words to communicate, but it is important to know whether delays in preverbal communication and language development have any effects on these associations. The aim of the present study was to examine associations between preverbal communication and early verbal skills in infancy and subsequent social-emotional competencies and ensuing social-emotional and behavioral problems in early toddlerhood. The role of background factors known to influence early language development was also examined. MethodsThe sample consisted of 395 children (51.6% boys) from the Finnish Steps Study cohort. Language was assessed at age 13 months (+ 1 month) with the MacArthur Communicative Development Inventory for Infants (CDI-I), and the social-emotional domain was assessed at age < 17 months with the Brief Infant–Toddler Social and Emotional Assessment (BITSEA). ResultsInfants with lower preverbal gestural communication and receptive language skills had a higher risk of delays in social-emotional competencies in toddlerhood than children with better communication skills, but not of elevated social-emotional and behavioral problems. ConclusionsThe results indicate that lower early communication skills can predict delays in the development of social-emotional competencies, which has been found to be a risk factor for later development of social-emotional and behavioral problems. It is important to monitor early communication skills to provide guidance to parents in supporting early pragmatic communication and language development in infancy, if needed.

Psychometric properties of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in two-year-old Ivorian and Ghanaian children

There is a lack of feasible and psychometrically sound instruments assessing social-emotional development in young children in low- and middle-income countries. The objective of this cross-sectional study was to investigate the psychometric properties of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) in two West-African populations. We administered the BITSEA in an interview-based mode to 289 mothers from Côte d'Ivoire and 227 mothers from Ghana for assessing their two-year-old children. In confirmatory factor analyses of four possible underlying theoretical models, we found only minimal support for the validity of the Problem scale and no support for the validity of the Competence scale. Consequently, without adaptation and subsequent validation of the modified version we cannot recommend the use of the BITSEA in West-African countries.

Detection of Early Warning Signs in Autism Spectrum Disorders: A Systematic Review

Due to the exponential increase of autism spectrum disorders’ prevalence in Western countries, it is necessary to improve early detection and intervention to enhance developmental milestones. This systematic review identified the most effective screening instrument, which can be used at an early age and which identifies the maximum number of autism cases. We identified several instruments with adequate predictive properties—the Autism Parent Screen for Infants (APSI), Battelle Development Inventory, second edition (BDI-2); Brief Infant-Toddler Social and Emotional Assessment (BITSEA); First Year Inventory (FYI); Infant-Toddler Checklist/Communication and Symbolic Behavior Scales Developmental Profile (ITC/CSBS-DP); Program of Research and Studies on AUTISM (PREAUT-Grid); Checklist for Early Signs of Developmental Disorders (CESDD); Social Attention and Communication Study (SACS); and the Screening Tool for Autism in Toddlers and Young Children (STAT)—that can be applied from 12 months of age in Western countries. The ITC/CSBS-DP has been proposed for universal screening from 12 months of age onwards, complemented by the Modified Checklist for Autism in Toddlers, Revised/Revised with Follow-Up (M-CHAT-R/F), which can be used from 15 months of age onwards. This strategy could improve early detection in at-risk children within the current health system, thus allowing for early intervention.

Third trimester maternal vitamin D and early childhood socioemotional development.

Whether maternal vitamin D affects offspring socioemotional development in early childhood has been underexplored. This study examined associations between maternal vitamin D during in the 3rd trimester and offspring socioemotional development between 30 and 59months. Data from 87 maternal-offspring pairs enrolled in the National Children's Study were used. Total plasma maternal vitamin D (25-hydroxyergocalciferol+25-hydroxycholecalciferol) was measured between 28 and 35 gestational weeks and categorised as quartiles (Q). Multivariable regression models, adjusting for maternal race/ethnicity, education, and prepregnancy body mass index (BMI [kg/m2 ]), were used to estimate the association between vitamin D and offspring scores on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). The mean (standard deviation) vitamin D concentration was 86.5 (27.8) nmol/L. The median (range) BITSEA problem score was 6.0 (0.0-30.0), and competence score was 19.0 (7.0-22.0). Maternal vitamin D was inversely related to offspring problem scores. Compared to offspring of women with 25(OH)D in Q1, offspring problem scores were -4.80 (95% confidence interval [CI] -8.29, -1.33) units lower for Q2 vs Q1, -5.64 (95% CI -9.60, -1.68) units lower for Q3 vs Q1, and -4.70 (95% CI -8.59, -0.82) units lower for Q4 vs Q1. Vitamin D was not associated with offspring competence score. Higher maternal vitamin D was associated with lower offspring behaviour problems and not associated with socioemotional competence. These data indicate the association of maternal vitamin D and offspring development may be dependent on the specific developmental component being investigated.

Caregiver Perceptions of Fatty Acid Supplementation to Toddlers Born Preterm.

* Abbreviations: ASD — : autism spectrum disorder Bayley-III — : Bayley Scales of Infant and Toddler Development, Third Edition BITSEA — : Brief Infant-Toddler Social and Emotional Assessment DHA — : docosahexaenoic acid PDDST-II — : Pervasive Developmental Disorders Screening Test–II, Stage 2 For the past several decades, it has been hoped that docosahexaenoic acid (DHA) and arachidonic acid supplementation to the preterm infant would improve cognitive outcomes. In this issue of Pediatrics, Boone et al1 present their findings regarding long-chain polyunsaturated fatty acid supplementation for 6 months to children between 10 and 16 months of age born <35 weeks’ gestation. Outcome measures, including caregiver reports of socioemotional development using the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) and the Pervasive Developmental Disorders Screening Test–II, Stage 2 (PDDST-II), revealed no evidence of benefit on broad socioemotional development, although there was a decrease in risk of clinical concern for autism spectrum disorder (ASD) among those who received supplementation. The investigators suggest cautious interpretation of results given the short time frame and the post hoc analysis. Cell, animal, and postmortem studies2,3 have shown that rates of DHA incorporation into the brain occur mainly from the last trimester of pregnancy until age 2. The study … Address correspondence to Susan S. Baker, MD, PhD, Department of Pediatrics, 39 Irving Place, Buffalo, NY 14201. E-mail: ssbaker{at}buffalo.edu

Human interaction in the NICU and its association with outcomes on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA)

BackgroundExtremely preterm infants represent one of the highest risk categories for impairments in social competence. Few studies have explored the impact of the neonatal intensive care unit (NICU) environment on social development. However, none have specifically analyzed the effects of the care structure the infant receives during hospitalization on later social competence indicators. ObjectiveTo identify associations between the care structures received by extremely preterm infants in the NICU and scores on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) post-discharge. Participants50 extremely preterm infants (mean gestational age: 25 weeks during hospitalization; mean chronological age during follow-up assessment: 2 years, 4 months). MethodsA secondary analysis of BITSEA data was performed exploring its relation to care structure data we extracted from electronic medical records (i.e., how much time infants were engaged in human interaction during their first thirty days of hospitalization and what types of interaction they were exposed to). ResultsExtremely preterm infants spend a considerable amount of time alone during hospitalization (80%) with nursing care comprising the majority of human interaction. Infants who experienced greater human interaction scored significantly higher on the Social Competence (p = 0.01) and lower on the Dysregulation (p = 0.03) BITSEA subscales. ConclusionHuman interaction and isolation in the NICU is associated with social competence and dysregulation outcomes in extremely preterm infants. Further research is needed to understand how various NICU care structures including centralized nursing teams, parental skin-to-skin care, and early therapy may synergistically play a positive role in developing social competence.

How are social-emotional and behavioral competences and problems at age 1 year associated with infant motor development? A general population study

Based on limitations in previous research evidence, we concluded that more research is needed for deeper understanding of how social-emotional and behavioral (SEB) outcomes among infant-toddler-aged children in the general population are associated with early motor development. In this study, we investigated associations between early competencies and problems, as measured by the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), and the timing of achievement of the main gross and fine motor milestones usually attained during the first year of life in a general population context. The study sample consisted of 515 infants (mean age 12.9 [SD 0.9] months) and their parents (514 mothers, 434 fathers), who were recruited in child health centers in Northern Finland. The infants were divided into two groups, based on their BITSEA screen status, and motor milestone achievement ages were compared across BITSEA screen status No Concern and Of-Concern infants. An Of-Concern screen status on the maternal and paternal Competence scale and Autism spectrum disorder (ASD) item cluster was associated with later infant achievement ages for gross motor milestones. By contrast, infants who were screened to be in the Of-Concern range on the maternal Problem scale achieved gross motor milestones earlier than infants with the corresponding No Concern screen status. No significant associations were found between the paternal Problem scale screen status and infant motor development. In further analyses, the strongest associations were found between an Of-Concern screen status on the paternal Competence scale and ASD item cluster and infant motor development. The findings indicate that the inclusion of infant motor developmental information may assist early identification and the clinical interpretation of parental reports of early SEB problems. Clinical implications of the current findings are discussed in the paper.

Association between Beta-Sympathomimetic Tocolysis and Risk of Autistic Spectrum Disorders, Behavioural and Developmental Outcome in Toddlers.

AIM:To investigate whether maternal intravenous beta-mimetic tocolytic therapy increases the risk of autistic spectrum disorders (ASD) and poorer behavioural and developmental outcomes.METHOD:Our study is a prospective case-control study among 90 children between 1.5 and three years old. Cases (n = 46) were toddlers with betamimetic tocolytic exposure; control group toddlers (n = 44) were tocolytic untreated. Treated and untreated groups were also divided into subgroups: term and preterm delivered. The gestational age of tocolytic treatment start, the dose and duration of exposure in hours were obtained from obstetric medical records. The Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the Modified Checklist for Autism in Toddlers (M-CHAT) and the Denver Developmental Screening Test (DDST) tests were applied for evaluation of social, emotional problems, autism and developmental disorders.RESULTS:Term and preterm born toddlers treated tocolytically in utero didn’t demonstrate a higher risk of autistic disorders or poorer behavioural and developmental results than controls. In the preterm group, the earliest start of tocolytic treatment was correlated with toddlers lower score of the Competencies Scale (p = 0.009) and a higher score of the Problems Scale (p = 0.048). Also, we concluded that preterm membrane rupture was associated with higher ASD risk in the untreated group (p = 0.043).CONCLUSION:Exposure to betamimetics during pregnancy was not associated with an increased risk of autism, behavioural and developmental disorders.

Do child healthcare professionals and parents recognize social-emotional and behavioral problems in 1-year-old infants?

Growing evidence supports the existence of clinically significant social-emotional/behavioral (SEB) problems among as young as 1-year-old infants. However, a substantial proportion of early SEB problems remain unidentified during contacts with child healthcare professionals. In this study, child healthcare nurse (CHCN; N=1008) and parental (N=518) reports about SEB worries were gathered, along with the maternal and paternal Brief Infant-Toddler Social and Emotional Assessment (BITSEA) ratings, for 12-month-old infants randomly recruited through Finnish child health centers. Only 1.4-1.8% of CHCNs, 3.9% of mothers, and 3.2% of fathers reported of being worried about the assessed child's SEB development. When the CHCNs' and parental reports were combined, 7.7% (33/428) of the infants assessed each by all three adults had one (7.0%), two (0.7%) or three (0%) worry reports. Even the combination of the CHCN's and parental worry reports identified only 7.0-13.8% of the infants with the maternal and/or paternal BITSEA Problem or Competence rating in the of-concern range. Identified associations across the three informants' worry reports, parental BITSEA ratings and sociodemographic factors are discussed in the paper. Routine and frequent use of developmentally appropriate screening measures, such as the BITSEA, might enhance identification and intervening of early SEB problems in preventive child healthcare by guiding both professionals and parents to pay more attention to substantial aspects of young children's SEB development and encouraging them to discuss possible problems and worries.

The Effectiveness of the BITSEA as a Tool to Early Detect Psychosocial Problems in Toddlers, a Cluster Randomized Trial.

ObjectiveEffective early detection tools are needed in child health care to detect psychosocial problems among young children. This study aimed to evaluate the effectiveness of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), in reducing psychosocial problems at one year follow-up, compared to care as usual.MethodWell-child centers in Rotterdam, the Netherlands, were allocated in a cluster randomized controlled trial to the intervention condition (BITSEA—15 centers), or to the control condition (‘care-as-usual’- 16 centers). Parents of 2610 2-year-old children (1,207 intervention; 1,403 control) provided informed consent and completed the baseline and 1-year follow-up questionnaire. Multilevel regression analyses were used to evaluate the effect of condition on psychosocial problems and health related quality of life (i.e. respectively Child Behavior Checklist and Infant-Toddler Quality of Life). The number of (pursuits of) referrals and acceptability of the BITSEA were also evaluated.ResultsChildren in the intervention condition scored more favourably on the CBCL at follow-up than children in the control condition: B = -2.43 (95% confidence interval [95%CI] = -3.53;-1.33 p<0.001). There were no differences between conditions regarding ITQOL. Child health professionals reported referring fewer children in the intervention condition (n = 56, 5.7%), compared to the control condition (n = 95, 7.9%; p<0.05). There was no intervention effect on parents’ reported number of referrals pursued. It took less time to complete (parents) or work with (child health professional) the BITSEA, compared to care as usual. In the control condition, 84.2% of the parents felt (very) well prepared for the well-child visit, compared to 77.9% in the intervention condition (p<0.001).ConclusionThe results support the use of the BITSEA as a tool for child health professionals in the early detection of psychosocial problems in 2-year-olds. We recommend future studies in large and varied populations to replicate these findings.Trial registrationCurrent Controlled Trials NTR2035