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

doi:10.1016/j.infbeh.2009.03.003

Infant Behavior and Development

Volume 32, Issue 3, June 2009, Pages 291-297

https://doi.org/10.1016/j.infbeh.2009.03.003 Get rights and content

Abstract

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.

Section snippets

Participants and setting

The study was carried out in Samsun, a province on the central-north coast of Turkey with approximately 1.2 million inhabitants. One- to four-year-old children constitute 6.1% of the total population in this city. This community sample consisted of 462 children who had applied to the primary health care centers located in the city for vaccination purposes. The sample sizes for all outpatient clinics were calculated according to the population rate—both urban (63.3%) and rural (36.7%) areas of

Results

There were no significant differences between maternal and paternal ratings on the BITSEA/P or BITSEA/C scores in any age or gender group (Table 1). In addition, both maternal and paternal BITSEA/P scores did not reveal significant differences between age groups (p > 0.05). However, consistent with the developmental nature of the BITSEA competence scale, both maternal and paternal BITSEA/C scores increased across the age groups (p < 0.001). Exploration for gender difference showed that only

Discussion

Overall results support that the Turkish version of the BITSEA is a valid and reliable screening tool for social and emotional problems of toddlers in primary health care settings. As 70% of parents returned the scales to the clinic and only 3.6% of mothers and 1.9% of fathers had missing values in more than two items, we conclude that the Turkish translation is quite understandable and may be easily used in primary health care settings. Internal consistency of BITSEA/P and BITSEA/C may be

References (26)

G. Baird et al.
A screening instrument for autism at 19 months of age: A 6-year follow-up study
Journal of Abnormal Child and Adolescent Psychiatry
(2000)
N. Erol et al.
Behavioral and emotional problems among Turkish children at ages 2 to 3 years
Journal of American Academy of Child and Adolescent Psychiatry
(2005)
J.M. Murphy et al.
Utility of the pediatric symptom checklist as a psychosocial screen to meet the federal early and periodic screening, diagnosis, and treatment (EPSDT) standards: A pilot study
Journal of Pediatrics
(1996)
D.S. Shaw et al.
Infant and toddler pathways leading to early externalizing disorders
Journal of American Academy of Child and Adolescent Psychiatry
(2001)
J.M. Thomas et al.
Practice parameters for the psychiatric assessment of infants and toddlers (0–36 months)
Journal of American Academy of Child and Adolescent Psychiatry
(1997)
J.M. Thomas et al.
Disruptive behavior in young children: What does it mean?
Journal of American Academy of Child and Adolescent Psychiatry
(2001)
T. Achenbach et al.
Manual for the ASEBA preschool forms and profiles
(2000)
American Academy of Pediatrics [AAP]
Committee on children with disabilities: Developmental surveillance and screening of infants and young children
Pediatrics
(2001)
G.M. Anderson et al.
Genesis of neocortex
M.J. Briggs-Gowan et al.
Brief Infant–Toddler Social and Emotional Assessment (BITSEA) manual, version 2.0
(2002)

M.J. Briggs-Gowan et al.

The Brief Infant–Toddler Social and Emotional Assessment: Screening for social-emotional problems and delays in competence

Journal of Pediatric Psychology

(2004)

M.J. Briggs-Gowan et al.

Discrepancies among mother, child, and teacher reports: Examining the contributions of maternal depression and anxiety

Journal of Abnormal Psychology

(1996)

A.S. Carter

Assessing social-emotional and behavior problems and competencies in infancy and toddlerhood: Available instruments and directions for Application

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Reliability and validity of the traditional Chinese translation of the brief infant-toddler social and emotional assessment
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Citation Excerpt :
Internal consistency in our sample was marginal (0.65–0.68) to adequate (>0.70), and these values were comparable to other language versions. Research has found that the BITSEA Problem scale consistently shows adequate internal consistency but is often marginal for the BITSEA Competence scale [34,42–44]. Despite the lower internal consistency found in both the present and other research on the Competence scale, it is important to note that these values are still within the acceptable range of a psychological scale [45].
Preterm birth and maternal sensitivity: Findings from a non-western country
2020, Infant Behavior and Development
Although there are several studies on maternal sensitivity of preterm-born children conducted in Western countries, the factors affecting the sensitivity of mothers of preterm infants have not been investigated outside the Western context.
This study aimed to compare maternal sensitivity of preterm children at 18 months of corrected age with their healthy term-born peers and explore the factors associated with maternal sensitivity in a middle-income non-Western country. Moreover, the associations of maternal sensitivity with socio-demographic factors, maternal depression, and social-emotional competency and behavior problems of infants were investigated.
In total, 70 (40 preterm-born and 30 term-born) mother-child dyads participated in this study. An observation-based measurement tool, Maternal Sensitivity Scale, was used to assess maternal sensitivity. Social-emotional competency and behavior problems of infants were evaluated via The Turkish version of the Brief Infant-Toddler Social Emotional Assessment. Maternal depressive symptoms were assessed via the Beck Depression Inventory. In addition, a demographic information form was filled out by the mothers.
Maternal sensitivity scores of preterm infants were significantly lower compared to term infants. Depressive symptoms scores and employment status of mothers, socio-economic status (SES), gestational age, breastfeeding duration, and behavior problems of children were the factors related to maternal sensitivity scores. In hierarchical regression analysis, SES and gestational age were the strongest predictors of maternal sensitivity. After controlling SES and gestational age, maternal depressive symptoms scores negatively predicted maternal sensitivity scores.
This study pointed out the factors associated with the maternal sensitivity of preterm infants outside the Western context. Interventions to improve sensitive parenting behaviors of preterm infants are needed, especially in socio-economically disadvantaged groups.
Impact of sleep behaviors on social and emotional problems in three-year-old children born prematurely
2020, Sleep Medicine
Childhood sleep problems have been associated with a number of negative health outcomes, but there is limited data on the relationship between sleep problems and social and emotional problems in preterm babies.
The aim of this study was to investigate sleep habits and the relationship between sleep problems and social and emotional problems in preterm infants with a corrected age of three years old.
The study included 40 preterm children and 40 full-term children. In order to evaluate the sleep habits and social and emotional problems of the children, their mothers completed the Brief Infant Sleep Questionnaire (BISQ) and the Brief Infant Toddler Social Emotional Assessment Scale (BITSEA) form.
It has been found that preterm children had longer sleeplessness at night than full-term children and the frequency of night awakening was also higher in full-term children. There was no difference between preterm and full-term children in terms of sleep duration, sleep location and methods of falling asleep. Although there was no difference between the two groups in the BITSEA problem scores, the BITSEA competence scores were significantly lower in preterm children compared to full-term children. In addition, considering the relationship between sleep behaviors and social and emotional problems in preterm infants, a significant correlation was found between short sleep duration at night, total sleep duration, and lower BITSEA competence scores. A late sleep time and social and emotional subclinical problem scores were also found to be correlated.
According to the results of this study, no significant difference was found in terms of sleep behaviors between preterm and full-term three-year-old children. However, BITSEA competence scores were lower in preterm children and an association has been found between sleep behaviors and social and emotional problems.
How are social-emotional and behavioral competences and problems at age 1 year associated with infant motor development? A general population study
2018, Infant Behavior and Development
Citation Excerpt :
A special strength of BITSEA is that it covers a wide range of early problems in the SEB domain in a brief, compact composition. Recent studies have evidenced acceptable psychometric properties for the BITSEA Competence and Problem total scales in Finland, France, the Netherlands, Turkey and the U.S. (Alakortes et al., 2015; Briggs-Gowan & Carter, 2006; Briggs-Gowan et al., 2004; Haapsamo et al., 2009; Karabekiroglu et al., 2009; Kruizinga et al., 2012; Wendland et al., 2014), and BITSEA has shown good discriminative power to identify children with and without ASD (Briggs-Gowan & Carter, 2006; Kruizinga et al., 2014). Given that early ASD features may manifest not only among young children with ASD, but also among children with other significant developmental delays (Ventola et al., 2007), we concluded that the BITSEA ASD item cluster (Briggs-Gowan & Carter, 2006) might be useful as an indicator of overall significant symptomatology in the current study context.
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.
A program based on Social Cognitive Theory and Smith's model of health and illness and its effect on maternal self-efficacy and child behavior
2016, Children and Youth Services Review
This study was conducted in order to determine the effect of a program based on Social Cognitive Theory and Smith's Model of Health and Illness on the self-efficacy, self-esteem and attitudes of mothers and on the emotional and behavioral problems and competence levels of their children.
This quasi-experimental study used a control group and a pretest-posttest design. The sample was composed of 77 mothers (experimental group, n = 39; control group, n = 38) who had low self-efficacy and self-esteem and whose children had problematic behavior. The mothers in the experimental group underwent a 10-session program over a period of 10 weeks. This program included activities to help them build trust in themselves and their surroundings, induce positive thinking, increase their childcare knowledge and skills, establish an effective interaction with their children, set realistic and positive goals, cope with stress, experience the feeling of success and become motivated. Data were collected by using the Demographic Information Form, the self-efficacy for Parenting Task Index-Toddler Scale, the Rosenberg Self-Esteem Scale, the Parent Attitude Scale and the Brief Infant-Toddler Social & Emotional Assessment. Data were collected before the start of the program, immediately after its completion and three months afterwards.
It was found that, at the end of the program and after the following three months, the self-efficacy, self-esteem and democratic attitude scores of the experimental group mothers and the competency scores of their children had significantly increased compared to their pre-program scores. The problem domain scores of their children had decreased and a statistically significant difference was detected in favor of the experimental group. In both the experimental and the control group, a weak negative correlation was found between the self-efficacy and democratic attitude scores of the mothers and the problem domain scores of their children.
The total 12-hour program created a positive change, even among the mothers with low self-efficacy, low self-esteem and low education and income levels who had problematic children. Therefore, healthcare professionals may find it beneficial to offer this program to all mothers having 2- and 3-year-old children.
Finnish mothers' and fathers' reports of their boys and girls by using the Brief Infant-Toddler Social and Emotional Assessment (BITSEA)
2015, Infant Behavior and Development
Citation Excerpt :
When significant sex differences have been found in the earlier BITSEA studies, girls have been rated higher than boys in competence scores, whereas problem total scores have been higher for boys than for girls (Briggs-Gowan et al., 2004; Briggs-Gowan & Carter, 2006; Karabekiroglu et al., 2009, 2013; Kruizinga et al., 2012, 2013). To our knowledge, only Turkish researchers have evaluated possible differences between the maternal and paternal BITSEA ratings so far, and they found no significant differences between the maternal and paternal scores in any age or sex groups (Karabekiroglu et al., 2009). As described above, there are only few studies focusing on possible sex differences in the occurrence and appearance of SEB problems among children younger than 2 years of age and comparing mothers’ and fathers’ reports about their young children's SEB problems and competencies.
This study investigated maternal and paternal reports about their very young boys and girls on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Two samples were recruited through child health centers in Northern Finland. The infant sample consisted of 227 children (112 boys and 115 girls) (mean age 13.0 ± 1.1 months) and the toddler sample consisted of 208 children (94 boys and 114 girls) (mean age 19.3 ± 1.4 months). Among the infants, girls obtained higher paternal competence total scores than boys, whereas among the toddlers, both maternal and paternal competence total scores were higher for girls compared to boys. In the problem total scale, boys were scored higher than girls by mothers, but not by fathers, in both age groups. In the externalizing problem domain, maternal scores were higher for boys compared to girls among both samples, whereas paternal scores were significantly higher for boys than for girls only among the infants. Also maternal internalizing problem scores were higher for boys than for girls among the toddlers. Compared to fathers, mothers perceived more social–emotional competencies in toddler boys and girls, as well as more total, externalizing and dysregulation problems in toddler boys. However, significant differences between the maternal and paternal BITSEA ratings were not found among the infants of either sex. The results suggest that sex differences in the social–emotional/behavior domain may be observed by the parents among children as young as 11 to 24 months of age. Our findings highlight the importance of paying attention to probable sex differences when assessing and treating early social–emotional/behavior problems.

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

Abstract

Section snippets

Participants and setting

Results

Discussion

Journal of Abnormal Child and Adolescent Psychiatry

Journal of American Academy of Child and Adolescent Psychiatry

Journal of Pediatrics

Journal of American Academy of Child and Adolescent Psychiatry

Journal of American Academy of Child and Adolescent Psychiatry

Journal of American Academy of Child and Adolescent Psychiatry

Manual for the ASEBA preschool forms and profiles

Committee on children with disabilities: Developmental surveillance and screening of infants and young children

Pediatrics

Genesis of neocortex

Brief Infant–Toddler Social and Emotional Assessment (BITSEA) manual, version 2.0

The Brief Infant–Toddler Social and Emotional Assessment: Screening for social-emotional problems and delays in competence

Journal of Pediatric Psychology

Discrepancies among mother, child, and teacher reports: Examining the contributions of maternal depression and anxiety

Journal of Abnormal Psychology

Assessing social-emotional and behavior problems and competencies in infancy and toddlerhood: Available instruments and directions for Application