Evaluation of an early detection tool for social-emotional and behavioral problems in toddlers: The Brief Infant Toddler Social and Emotional Assessment - A cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>The prevalence of social-emotional and behavioral problems is estimated to be 8 to 9% among preschool children. Effective early detection tools are needed to promote the provision of adequate care at an early stage. The Brief Infant-Toddler Social and Emotional Assessment (BITSEA) was developed for this purpose. This study evaluates the effectiveness of the BITSEA to enhance social-emotional and behavioral health of preschool children.</p> <p>Methods and Design</p> <p>A cluster randomized controlled trial is set up in youth health care centers in the larger Rotterdam area in the Netherlands, to evaluate the BITSEA. The 31 youth health care centers are randomly allocated to either the control group or the intervention group. The intervention group uses the scores on the BITSEA and cut-off points to evaluate a child's social-emotional and behavioral health and to decide whether or not the child should be referred. The control group provides care as usual, which involves administering a questionnaire that structures the conversation between child health professionals and parents. At a one year follow-up measurement the social-emotional and behavioral health of all children included in the study population will be evaluated.</p> <p>Discussion</p> <p>It is hypothesized that better results will be found, in terms of social-emotional and behavioral health in the intervention group, compared to the control group, due to more adequate early detection, referral and more appropriate and timely care.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2035">NTR2035</a></p

Reliability and Validity of the Dutch Version of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA)

Background: The Brief Infant-Toddler Social and Emotional Assessment (BITSEA) is a relatively new and short (42-item) questionnaire that measures psychosocial problems in toddlers and consists of a Problem and a Competence scale. In this study the reliability and validity of the Dutch version of the BITSEA were examined for the whole group and for gender and ethnicity subgroups. Methods: Parents of 7140 two-year-old children were invited in the study, of which 3170 (44.4%) parents completed the BITSEA. For evaluation of the score distribution, the presence of floor/ceiling effects was determined. The internal consistency (Cronbach's alpha) was evaluated and in subsamples the test-retest, parent-childcare provider interrater reliability and concurrent validity with regard to the Child Behavioral Checklist (CBCL). Discriminative validity was evaluated by comparing scores of parents that worry and parents that do not worry about their child's development. Results: The BITSEA showed no floor or ceiling effects. Psychometric properties of the BITSEA Problem and Competence scale were respectively: Cronbach's alphas were 0.76 and 0.63. Test-retest correlations were 0.75 and 0.61. Interrater reliability correlations were 0.30 and 0.17. Concurrent validity was as hypothesised. The BITSEA was able to discriminate between parents that worry about their child and parents that do not worry. The psychometric properties of the BITSEA were comparable across gender and ethnic background. Conclusion: The results in this large-scale study of a diverse sample support the reliability and validity of the BITSEA Problem scale. The BITSEA Competence scale needs further study. The performance of the BITSEA appears to be similar in subgroups by gender and ethnic background

A follow-up study of children's communicative development:associations to social-emotional and behavioural problems and competences and experienced maternal stress

Abstract The aim of this study was to follow 8 to 36- month old children's communicative development and its' associations with social-emotional skills (the Brief Infant Toddler Social-Emotional Assessment, BITSEA) and behavioural problems. This study is the first study using the Finnish version of the BITSEA. A total of 50 children participated in the Oulu region (first phases at year 2006 and 2007). At the age of 8 months (at year 2006, n&#160;= &#160;31), child participants were grouped into two conditions: 1) children possibly needing support for deficiencies in communicative and interaction skills and 2) children without noted areas of need of support in communicative and interaction skills. Through random sampling, three groups were formed and included children from both the above mentioned conditions. The groups met fortnightly for five months for a directed song-play session (enrichment intervention). The sample size was increased at year 2007 (n&#160;= &#160;19) and follow-up questionnaires were sent to all of the participating families (N&#160;= &#160;50) at the child's age of 18, 24 and 36 months. The sample during the year 2007 did not receive any intervention. Results suggest, that the children's communicative and social-emotional development may be linked to each other. Children who scored higher in the assessments in communicative skills were also more successful on assessments measuring social interaction and social-emotional competence. Children with better communication skills demonstrated higher scores after enrichment-intervention. Scores on the BITSEA demonstrated an association with other indicators of children's development employed in the study suggesting the utility of the BITSEA as a follow-up assessment in Finnish sample. Mothers, who rated high maternal stress (measured at the child's age of 8 months) also rated higher levels of social-emotional and behavioural problems in their children, especially when a child was 18 months. This effect appeared to decrease over time. Results indicate the clinical importance of directly measuring not only a child's linguistic and social-emotional development, but also including assessment of a child's immediate environment, such as parents and siblings.Tiivistelmä Tutkimuksen tarkoituksena oli seurata 8-36 kuukauden ikäisten lasten kielellistä kehitystä ja sen yhteyttä sosioemotionaaliseen kehitykseen (Brief Infant Toddler Social-Emotional Assessment, BITSEA-lomake) sekä käyttäytymisen ongelmiin. Tämä oli ensimmäinen tutkimus Suomessa, jossa käytettiin BITSEAn suomenkielistä versiota. Tutkimukseen osallistui 50 perhettä (aloitus vuosina 2006 ja 2007) Oulun alueelta. Kahdeksan kuukauden iässä täytettyjen lomakkeiden perusteella (vuonna 2006, n&#160;= &#160;31) lapset luokiteltiin vuorovaikutus- ja kommunikaatiotaitojen mukaan kahteen joukkoon: 1) Vuorovaikutus- ja kommunikaatiotaitojen tukea mahdollisesti tarvitsevat lapset ja 2) Lapset, joilla ei todennäköisesti ollut tuen tarvetta vuorovaikutus- ja kommunikaatiotaidoissa. Satunnaisotannalla muodostettiin kolme pienryhmää (rikastuttamisryhmät), joihin kuului sekä mahdollista tukea tarvitsevia että tukea tarvitsemattomia lapsia. Ryhmät kokoontuivat joka toinen viikko viiden kuukauden ajan ohjattuun laulu-leikkituokioon. Tutkimusta laajennettiin syksyllä 2007 (n&#160;= &#160;19) ja kaikille tutkimukseen osallistuneille perheille (N = 50) lähetettiin seurantalomakkeita, jotka vanhempien tuli täyttää lapsen ollessa 18, 24 ja 36 kuukauden ikäinen. Vuoden 2007 otoksen perheille ei tarjottu perheinterventiota. Tutkimuksessa kävi ilmi, että lapset, jotka saivat korkeat pisteet sosioemotionaalista kompetenssia kuvaavissa kartoituksissa, menestyivät paremmin myös vuorovaikutus- ja kommunikaatiotaitoja kuvaavissa arvioinneissa. Lapset, joilla oli jo ennestään korkeammat pisteet vuorovaikutus- ja kommunikaatiotaitoja kuvaavissa lomakkeissa, näyttivät saavan korkeammat pisteet myös intervention jälkeen. Tutkimuksessa tuli esiin, että BITSEA -lomake korreloi hyvin muiden lasten kehityksen seurannassa käytettyjen mittareiden kanssa ja soveltuu siten hyvin tutkimuslomakkeeksi suomalaisessakin aineistossa. Lisäksi äidit, jotka arvioivat stressitasonsa korkealle (lapsen ollessa kahdeksan kuukauden ikäinen), arvioivat myöhemmin myös korkeampia pisteitä lasten sosioemotionaalisten ja käyttäytymisen ongelmien kyselylomakkeissa lapsen ollessa 18 kuukauden ikäinen. Tämä vaikutus kuitenkin väheni lapsen kasvaessa. Tutkimustulokset osoittavat, että perhe- ja neuvolatyössä on lapsen kehityksen kannalta tärkeää huomioida myös hänen kasvuympäristönsä; vanhempien hyvinvointi ja sisarusten määrä vaikuttavat lapsen kielelliseen ja sosioemotionaaliseen kehitykseen

Peripheral chemoreflex activation and cardiac function during hypoxemia in near term fetal sheep without placental compromise.

A drop in arterial oxygen content activates fetal chemoreflex including an increase in sympathetic activity leading to peripheral vasoconstriction and redistribution of blood flow to protect the brain, myocardium, and adrenal glands. By using a chronically instrumented fetal sheep model with intact placental circulation at near-term gestation, we investigated the relationship between peripheral chemoreflex activation induced by hypoxemia and central hemodynamics. 17 Åland landrace sheep fetuses at 115-128/145 gestational days were instrumented. Carotid artery was catheterised in 10 fetuses and descending aorta in 7 fetuses. After a 4-day recovery, baseline measurements of fetal arterial blood pressures, blood gas values, and fetal cardiovascular hemodynamics by pulsed Doppler ultrasonography were obtained under isoflurane-anesthesia. Comparable data to baseline was collected 10 (acute hypoxemia) and 60 minutes (prolonged hypoxemia) after maternal hypo-oxygenation to saturation level of 70-80% was achieved. During prolonged hypoxemia, pH and base excess (BE) were lower, and lactate levels higher in the descending aorta than in the carotid artery. During hypoxemia mean arterial blood pressure (MAP) in the descending aorta increased, while in the carotid artery MAP decreased. In addition, right pulmonary artery pulsatility index values increased, and the diastolic component in the aortic isthmus blood flow velocity waveform became more retrograde. Both fetal ventricular cardiac outputs were maintained even during prolonged hypoxemia when significant fetal metabolic acidemia developed. Fetal chemoreflex activation induced by hypoxemia decreased the perfusion pressure in the cerebral circulation. Fetal weight-indexed LVCO or AoI Net Flow-ratio did not correlate with a drop in carotid artery blood pressure

Foramen ovale blood flow and cardiac function after main pulmonary artery occlusion in fetal sheep

Abstract The foramen ovale (FO) accounts for the majority of fetal left ventricular (LV) output. Increased right ventricular afterload can cause a redistribution of combined cardiac output between the ventricles. To understand the capability of the FO to increase its volume blood flow and thus LV output, we mechanically occluded the main pulmonary artery in seven chronically instrumented near‐term sheep fetuses. We hypothesized that FO volume blood flow and LV output would increase during main pulmonary artery occlusion. Fetal cardiac function and haemodynamics were assessed by pulsed and tissue Doppler at baseline, 15 and 60 min after occlusion of the main pulmonary artery and 15 min after occlusion was released. Fetal ascending aorta and central venous pressures and blood gas values were monitored. Main pulmonary artery occlusion initially increased fetal heart rate (P &lt; 0.05) from [mean (SD)] 158 (7) to 188 (23) beats min⁻¹ and LV cardiac output (P &lt; 0.0001) from 629 (198) to 776 (283) ml min⁻¹. Combined cardiac output fell (P &lt; 0.0001) from 1524 (341) to 720 (273) ml min⁻¹. During main pulmonary artery occlusion, FO volume blood flow increased (P &lt; 0.001) from 507 (181) to 776 (283) ml min⁻¹. This increase was related to fetal tachycardia, because LV stroke volume did not change. Fetal ascending aortic blood pressure remained stable. Central venous pressure was higher (P &lt; 0.05) during the occlusion than after it was released. During the occlusion, fetal pH decreased and PCO₂ increased. Left ventricular systolic dysfunction developed while LV diastolic function was preserved. Right ventricular systolic and diastolic function deteriorated after the occlusion. In conclusion, the FO has a limited capacity to increase its volume blood flow at near‐term gestation

Peripheral chemoreflex activation and cardiac function during hypoxemia in near-term fetal sheep without placental compromise

Abstract A drop in arterial oxygen content activates fetal chemoreflex including an increase in sympathetic activity leading to peripheralvasoconstriction and redistribution of bloodflow to protect the brain, myocardium, and adrenal glands. By using a chronicallyinstrumented fetal sheep model with intact placental circulation at near-term gestation, we investigated the relationship betweenperipheral chemoreflex activation induced by hypoxemia and central hemodynamics. A total of 17 Åland landrace sheep fetusesat 115–128/145 gestational days were instrumented. Carotid artery was catheterized in 10 fetuses and descending aorta in 7fetuses. After a 4-day recovery, baseline measurements of fetal arterial blood pressures, blood gas values, and fetal cardiovascu-lar hemodynamics by pulsed Doppler ultrasonography were obtained under isoflurane anesthesia. Comparable data to baselinewere collected 10 min (acute hypoxemia) and 60 min (prolonged hypoxemia) after maternal hypo-oxygenation to saturation levelof 70%–80% was achieved. During prolonged hypoxemia, pH and base excess (BE) were lower and lactate levels were higher inthe descending aorta than in the carotid artery. During hypoxemia mean arterial blood pressure (MAP) in the descending aortaincreased, whereas in the carotid artery, MAP decreased. In addition, right pulmonary artery pulsatility index values increased,and the diastolic component in the aortic isthmus bloodflow velocity waveform became more retrograde, thus decreasing theaortic isthmus antegrade/retrograde bloodflow (AoI Net Flow) ratio. Both fetal ventricular cardiac outputs were maintained evenduring prolonged hypoxemia when significant fetal metabolic acidemia developed. Fetal chemoreflex activation induced by hy-poxemia decreased the perfusion pressure in the cerebral circulation. Fetal weight-indexed left ventricular cardiac output (LVCO)or AoI Net Flow ratio did not correlate with a drop in carotid artery blood pressure