Brief Infant Toddler Social Emotional Assessment Research Articles

Trajectories of maternal depressive and anxiety symptoms and child's socio-emotional outcome during early childhood

Maternal symptoms of depression and anxiety during pregnancy and early postnatal years are suggested to impose differential negative effects on child's socio-emotional development depending on the characteristics of the symptoms, such as timing, intensity, and persistence. The aim of this study was to identify trajectories of maternal depressive and anxiety symptoms from pregnancy until 2 years postpartum and to examine their relationship with child socio-emotional problems and competence at 2 and 5 years of age.The sample included 1208 mother-infant dyads from FinnBrain Birth Cohort study. Latent growth mixture modelling (LGMM) was utilized to model the trajectories of maternal depressive symptoms, measured using the Edinburgh Postnatal Depression Scale (EPDS), and general anxiety, measured with Symptom Checklist-90 (SCL-90) at 14, 24, and 34 weeks' gestation (gw) and at 3, 6 and 24 months postpartum. Maternal depression was also assessed at 12 months. Child socio-emotional problems and competence were evaluated using the Brief Infant Toddler Social Emotional Assessment (BITSEA) at 2 years and Strengths and Difficulties Questionnaire (SDQ) at 5 years. Relevant background factors and maternal concurrent symptomatology were controlled for.The trajectories of maternal depressive and anxiety symptoms were associated negatively with differential aspects of child long term socio-emotional outcomes from early toddlerhood to preschool years. The trajectories of depressive symptoms and high-level persistent symptoms that continued from pregnancy to two years of child age had the strongest negative association with child outcomes. This highlights the importance of identifying and treating maternal symptomatology, especially that of depression, as early as possible.

Aperiodic electrophysiological activity in preterm infants is linked to subsequent autism risk.

Approximately 7% of preterm infants receive an autism spectrum disorder (ASD) diagnosis. Yet, there is a significant gap in the literature in identifying prospective markers of neurodevelopmental risk in preterm infants. The present study examined two electroencephalography (EEG) parameters during infancy, absolute EEG power and aperiodic activity of the power spectral density (PSD) slope, in association with subsequent autism risk and cognitive ability in a diverse cohort of children born preterm in South Africa. Participants were 71 preterm infants born between 25 and 36weeks gestation (34.60±2.34weeks). EEG was collected during sleep between 39 and 41weeks postmenstrual age adjusted (40.00±0.42weeks). The Bayley Scales of Infant Development and Brief Infant Toddler Social Emotional Assessment (BITSEA) were administered at approximately 3 years of age adjusted (34±2.7 months). Aperiodic activity, but not the rhythmic oscillatory activity, at multiple electrode sites was associated with subsequent increased autism risk on the BITSEA at three years of age. No associations were found between the PSD slope or absolute EEG power and cognitive development. Our findings highlight the need to examine potential markers of subsequent autism risk in high-risk populations other than infants at familial risk.

The association between social emotional development and symptom presentation in autism spectrum disorder.

Understanding differences in social-emotional behavior can help identify atypical development. This study examined the differences in social-emotional development in children at increased risk of an autism spectrum disorder (ASD) diagnosis (infant siblings of children diagnosed with the disorder). Parents completed the Brief Infant-Toddler Social-Emotional Assessment (BITSEA) to determine its ability to flag children with later-diagnosed ASD in a high-risk (HR) sibling population. Parents of HR (n = 311) and low-risk (LR; no family history of ASD; n = 127) children completed the BITSEA when their children were 18 months old and all children underwent a diagnostic assessment for ASD at age 3 years. All six subscales of the BITSEA (Problems, Competence, ASD Problems, ASD Competence, Total ASD Score, and Red Flags) distinguished between those in the HR group who were diagnosed with ASD (n = 84) compared to non-ASD-diagnosed children (both HR-N and LR). One subscale (BITSEA Competence) differentiated between the HR children not diagnosed with ASD and the LR group. The results suggest that tracking early social-emotional development may have implications for all HR children, as they are at increased risk of ASD but also other developmental or mental health conditions.

Does the Psychopathology of the Parents Predict the Developmental-Emotional Problems of the Toddlers?

Parental psychopathology has been defined in respect of psychopathological development in early childhood. This study aimed to investigate the effects of parental psychopathologies on social and emotional problems in the age range of 1-3 years and to determine children at risk. The study data were obtained from the 2009 Early Childhood Mental Health Profile taking population distribution into consideration with the properties representing Turkey. The primary caregiver of the child completed the Psychiatric Evaluation Form for 1-3 years, the Brief Infant-Toddler Social Emotional Assessment (BITSEA), the Ages and Stages Questionnaire (ASQ), and the Brief Symptom Inventory (BSI) for themselves. Machine learning models used for prediction. The performance of prediction models was evaluated with the ten-fold cross-validation method. Area Under Curve (AUC) values were calculated with Receiver Operating Characteristic (ROC) curves to evaluate the performance of each model. The evaluation was made of the data of 2775 children, comprising 1507 (54.3%) males and 1268 (45.7%) females with a mean age of 26.19±9.11 months (range, 10-48 months). A total of 106 children were identified as at risk, as they were above the clinical cut-off point (1.5 standard deviations) of the BITSEA points and below the cut-off points of any one of the developmental areas of the ASQ. Modeling was applied to the data of these 106 children. The Support Vector Machines (SVM) model was selected for prediction with the automatically optimized highest AUC value. Weighting for the SVM algorithm showed mothers' BSI scores, fathers' education and health problems, duration of breastfeeding, unplanned pregnancy are significant for predicting BITSEA-problem scores in the model. To be able to understand the complex relationship with parental psychopathology and behavioral problems, machine learning methods were used successfully in this study. Further studies with more massive data sets, more extended follow-up periods, and stronger algorithms will be able to identify risk groups earlier and allow early interventions to be implemented.

Socioemotional and Autism Spectrum Disorder Screening for Toddlers in Early Intervention: Agreement Among Measures

Identification of problems with socioemotional functioning is an important task in early childhood, particularly for children in early intervention (EI). However, socioemotional concerns raised by families may be under-identified in practice. In accordance with Division for Early Childhood (DEC) recommended practices, Part C providers could benefit from additional guidance on socioemotional screening and assessment, including additional research on available tools. Therefore, we examined agreement among three commonly used measures of socioemotional functioning in an EI sample ( N = 50). Overall, the measures did not have adequate agreement. We found substantial agreement between the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE, first edition) and the Brief Infant Toddler Social-Emotional Assessment (BITSEA), moderate agreement between the ASQ:SE and the Child Behavior Checklist (CBCL), and fair agreement between the BITSEA and CBCL. We also examined their potential to screen for autism spectrum disorder (ASD) by examining agreement with the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F). The BITSEA had substantial agreement with the M-CHAT-R/F, providing initial support for its use as an ASD screener. These findings are preliminary and further study in larger, more diverse samples would be beneficial. Evaluation of the sensitivity and specificity of these tools is also needed.

Behavioral Deficits at 18-22 Months of Age Are Associated with Early Cerebellar Injury and Cognitive and Language Performance in Children Born Extremely Preterm

To investigate associations in toddlers born extremely preterm (<28 weeks) between neonatal neuroimaging and 18- to 22-month developmental and behavioral outcomes. Cohort analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Surfactant Positive Airway Pressure and Pulse Oximetry Trial Neuroimaging and Neurodevelopmental Outcomes Study of infants born extremely preterm. Subjects underwent cranial ultrasonography and near-term magnetic resonance imaging (MRI). At 18-22 months of corrected age, the assessment included the Brief Infant Toddler Social Emotional Assessment (BITSEA) Problem and Competence Scale scores and the Bayley Scales of Infant Development, Third Edition (Bayley-III). The BITSEA Problem Scale assesses dysregulation; the Competence Scale assesses social-emotional competence. We examined associations of Problem and Competence scores and positive screen rates with cranial ultrasonography and near-term MRI. Mean BITSEA and Bayley-III scores were compared using ANOVA and positive screen rates with the χ2 test. We computed correlations between BITSEA and Bayley-III scores. Of the 397 children, positive BITSEA screens were found in 34% for the Problem score and 26% for the Competence score. Presence of lesions on near-term MRI that included cerebellar lesions were significantly associated with lower BITSEA Competence but not with Problem scores; Competence scores were inversely related to the presence/significance of lesions. Positive screens on Competence scores and on both Competence and Problem scores were significantly associated with Bayley-III cognitive and language scores <85 (P < .001). Social-emotional competence contributes to deficits in cognitive and language development. Presence of injury on near-term MRI that includes cerebellar lesions is associated with later social-emotional competence and may be a useful predictor to guide early assessment and intervention. ClinicalTrials.gov: NCT00063063 and NCT00233324.

Screening Accuracy of the Brief Infant Toddler Social-Emotional Assessment to Identify Autism Spectrum Disorder in Toddlers Born at Less Than 30Weeks' Gestation.

Despite the higher prevalence of autism spectrum disorder (ASD) in children born preterm, valid screening tools for use in preterm populations are lacking. We aimed to evaluate the screening accuracy of the Brief Infant Toddler Social-Emotional Assessment (BITSEA) and to compare it to the Pervasive Developmental Disorders Screening Test-II, Stage 2, Developmental Clinic Screener (PDDST-II-DCS) in identifying ASD diagnosis in toddlers born at < 30weeks' gestation. Caregivers (94% mothers) of 555 children completed questionnaires (BITSEA, PDDST-II-DCS, socio-demographics) when the children (58% male) were 18-36months. Medical charts were abstracted 3.5years later and showed that 4% (n = 24) of children had an ASD diagnosis. BITSEA competence (sensitivity = .74; specificity = .76) and ASD (sensitivity = .70; specificity = .73) subscales demonstrated better accuracy in identifying ASD compared to the recommended PDDST-II-DCS cut-score (sensitivity = .73; specificity = .64), specifically as it related to specificity. Additional studies are needed in other preterm populations to replicate these findings.

0982 SHORT SLEEP DURATION AND OBJECTIVE BEHAVIORAL PATTERNS IN VERY YOUNG AFRICAN AMERICAN AND CAUCASIAN URBAN CHILDREN: A CANDLE STUDY DATA ANALYSIS

Racial and socioeconomic disparities are known to negatively affect sleep duration in school-aged children and adults. Little is known about how very young African American (AA) and Caucasian (C) children (1-year-olds) differ in nocturnal and daytime sleep duration and how this may affect daytime behavioral patterns. The purpose of this study was to determine differences in total sleep duration between AA and C 1-year-olds and how nighttime and daytime total sleep hours and number of minutes awake during the night relates to objective behavioral performance measures. We analyzed data from the first-year clinic visits (N=1056) (mean SD) (1.08 years 0.12) of predominantly AA (n=663) and C (n=393) children living in Shelby County, TN enrolled in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study. T-tests for differences between total nocturnal and daytime sleep hours and number of minutes awake during the night (all reported by parent) between races and bivariate correlations determined if sleep periods were associated with Brief Infant Toddler Social Emotional Assessment (BITSEA) total and subscale scores for externalizing and internalizing behavior problems. AA children slept significantly fewer hours than C children during daytime (7am-7pm) (2.6 1.5 v 2.9 1.1, p<0.001) and nighttime (7pm - 7am) hours (9.2 1.4 v 10.4 1.1) respectively. AA were awake more minutes during the night (18.7 40.9) than C (8.9 25.3, p <0.001). Total nighttime sleep hours were significantly correlated with Externalizing (r= -.20, p < 0.001) and Internalizing BITSEA subscales (r= -.20, p < 0.001) as were nighttime wake minutes (r= .14, p<0.001 and r= .11, p<0.001, respectively). Daytime hours of sleep were non-significantly correlated to the BITSEA scores. Urban 1-year-old AA children sleep significantly less during nighttime and daytime hours than their C counterparts. Fewer total night minutes of sleep corresponded with higher (i.e, more impaired) scores for externalizing and internalizing behaviors while more minutes of wake during the night resulted in similar behavior patterns. More focus must be given to alerting urban communities of the importance of adequate nighttime sleep for their very young children. Urban Child Institute

Developing Autism Screening Criteria for the Brief Infant Toddler Social Emotional Assessment (BITSEA).

There is a critical need for evidence-based, broadband behavioral, and ASD screening measures for use in pediatric and early educational settings to ensure that young children at risk for developing social-emotional disorders and/or ASD are provided with early intervention services to optimize long-term outcomes. The BITSEA is a 42-item screener designed to identify social-emotional/behavioral problems and delays/deficits in social-emotional competence among 11-48-month-olds; 19 items describe behaviors consistent with ASD. Secondary data analysis was employed to develop cut-scores for ASD subscales using Receiver Operating Curves, discriminating children with (n = 223) and without (n = 289) ASD. Cut-scores demonstrated moderate-to-high discriminative power, sensitivity, specificity, and PPV. Findings highlight feasibility of using a broadband social-emotional competence and behavior problem screener to improve early detection of ASD.

Participation in the special supplemental nutrition program for women, infants, and children is not associated with early childhood socioemotional development: Results from a longitudinal cohort study.

Socioemotional development in early childhood has long-term impacts on health status and social outcomes, and racial and socioeconomic disparities in socioemotional skills emerge early in life. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an early childhood nutrition intervention with the potential to ameliorate these disparities. Our objective was to assess the impact of WIC on early socioemotional development in a longitudinal study. We examined the association between WIC participation and scores on the Brief Infant Toddler Social Emotional Assessment (BITSEA) in 327 predominantly African American mother–child dyads who were participants in the longitudinal Conditions Affecting Neurocognitive Development in Early Life (CANDLE) Study (Memphis, TN). To account for selection bias, we used within-child fixed effects to model the variability in each child's BITSEA scores over two measurement occasions (ages 12 and 24 months). Final models were adjusted for time-varying characteristics including child age, maternal stress, mental health, child abuse potential, marital status, and food stamp participation. In fully adjusted models, we found no statistically significant effect of WIC on change in socioemotional development (β = 0.22 [SD = 0.39] and β = − 0.58 [SD = 0.79] for BITSEA Competence and Problem subdomains, respectively). Using rigorous methods and a longitudinal study design, we found no significant association between WIC and socioemotional development in a high needs population. This finding suggests that early childhood interventions that more specifically target socioemotional development are necessary if we are to reduce racial disparities in socioemotional skills and prevent poor social and health outcomes across the life course.

Systematic Review: Classification Accuracy of Behavioral Screening Measures for Use in Integrated Primary Care Settings.

OBJECTIVE: To examine the classification accuracy of measures of overall psychopathology recommended for pediatric primary care screening. METHOD : A systematic review identified relevant instruments described in the literature. Subsequent systematic reviews identified studies of sensitivity (SE) and specificity (SP) of each measure for various cutoffs and different criteria for disorder (e.g., caseness determined by structured interview, exceeding a cutoff score, referral for psychiatric evaluation). RESULTS : Measures include the Child Behavior Checklist (CBCL), Pediatric Symptom Checklist (PSC), Strengths and Difficulties Questionnaire (SDQ), Brief Infant-Toddler Social Emotional Assessment (BITSEA), and the Ages and Stages Questionnaire: Social-Emotional scale (ASQ:SE). For three measures (CBCL, PSC, and SDQ) studied extensively, achieving relatively high SE and SP values (≥ .70) simultaneously occurred in only 30-55% of the studies reviewed. There are relatively few studies of the ASQ:SE and BITSEA, or of relatively new measures. DISCUSSION : Documented utility of these measures as screening instruments is limited.

The Long Term Impact of Micronutrient Supplementation during Infancy on Cognition and Executive Function Performance in Pre-School Children.

Brain growth and development are critically dependent on several micronutrients. During early development cellular activity may be sensitive to micronutrient deficiencies, however the evidence from human studies is equivocal. The objective of this study was to examine the long-term cognitive and social-emotional effects of multiple micronutrient supplementation compared with iron supplementation alone, administered during infancy. This study was a follow-up to an initial randomized, double-blind controlled trial (RCT) in 2010 in which 902 infants, aged 6–17 months, from Lima, Peru, were given daily supplements of either iron (Fe) or multiple micronutrients (MMN) including zinc (451 in each group). The supplementation period for both groups was six months. In 2012, a subsample of 184 children from the original cohort (now aged 36–48 months) was randomly selected to participate in a follow-up trial and was assessed for intelligence, working memory, inhibition, and executive function. The tests showed no significant differences between the supplementation groups though there were some gender differences, with girls displaying higher scores than boys across both groups on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) Verbal IQ sentences subtest, the Day-Night cognitive test and on the Brief Infant-Toddler Social Emotional Assessment (BITSEA) social competency, and boys scoring higher than girls in problem behaviour. The results indicate that MMN supplementation had no long term additional effects on cognitive function compared with iron supplementation alone. The timing of supplement administration for maximum impact on a child’s cognitive development requires further investigation.

Clinical Validity of a Brief Measure of Early Childhood Social–Emotional/Behavioral Problems

To address a pressing need for measures of clinically significant social-emotional/behavioral problems in young children by examining several validity indicators for a brief parent-report questionnaire. An ethnically and economically diverse sample of 213 referred and nonreferred 2- and 3-year-olds was studied. The validity of the Brief Infant-Toddler Social-Emotional Assessment (BITSEA) Problem Index and Internalizing and Externalizing scales was evaluated relative to a "gold standard" diagnostic interview, as well as the Child Behavior Checklist (CBCL). The validity of the BITSEA Problem Index relative to Diagnosis (sensitivity = 72.7%-80.8%, specificity = 70.0%-83.3%) and clinical-range CBCL scores (sensitivity = 80.0%-96.2%, specificity = 75.0%-89.9%) was supported in the full sample and within minority/nonminority groups. Additional results supported the validity of the BITSEA Internalizing and Externalizing scales. Documented validity suggests that the BITSEA may be a valuable tool to aid screening, identification, and assessment efforts targeting early-emergent social-emotional/behavioral problems. Practical implications and generalizability are discussed.

A pilot longitudinal follow-up study of the Brief Infant Toddler Social–Emotional Assessment (BITSEA) in Northern Finland: examining toddlers’ social–emotional, behavioural and communicative development

Developmental needs should be assessed in early infancy and followed longitudinally to improve identification, prevention and intervention efforts.The objective was to examine the relationship between competencies and areas of need in toddlers’ development, and to describe the properties and utility of the Brief Infant Toddler Social–Emotional Assessment (BITSEA) in a pilot study in Northern Finland. Parents (N = 50) evaluated toddler development at 18 and 36 months. Assessments included the BITSEA, the Child Behavior Checklist and the MacArthur Communicative Development Inventories. Lower communicative skills were associated with an increase in toddler behavioural problems. Social–emotional competence (S-EC) was associated with better communication development. Parents reporting enhanced communication skills and S-EC in their toddlers also reported fewer behavioural problems in their young children; however, further research employing the BITSEA in a larger and heterogeneous sample of Finnish children is needed to determine appropriate cut-off scores and reliability especially for the unique subscales of BITSEA.

The reliability and validity of the Turkish version of the brief infant–toddler social emotional assessment (BITSEA)

In this study the reliability and validity of the Turkish version of the brief infant–toddler social emotional assessment (BITSEA) were investigated in a community sample. The sample consisted of 462 children (mean age: 24.60 ± 7.93 [12–42] months) who had applied to Turkish health centers for immunization. Both parents completed the BITSEA; mothers completed the child behavior checklist 2/3 (CBCL). Internal consistencies of the BITSEA–problem (P) and competence (C) scales were good to excellent (Cronbach's α = 0.82 and 0.72, respectively). Interrater reliability between parents and test–retest reliability were good. BITSEA/P scores were significantly correlated with CBCL internalizing, externalizing and total problem scores ( p < 0.001). Maternal BITSEA/P cutpoint scores revealed that 30.6% of male toddlers and 28.6% of females were in the subclinical range and 13.1% of males and 17.6% of females were in clinical range. Results reveal that the Turkish version of BITSEA is a reliable, valid and simply applicable instrument for screening social, emotional and behavioral problems among toddlers. Clinical validation of the BITSEA/C and BITSEA/P is warranted.