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Biomedical subjects

Margaret J Briggs-Gowan

Publications and source records attributed to Margaret J Briggs-Gowan.

11 recordsLinked to original sources
PubMed2006

Are infant-toddler social-emotional and behavioral problems transient?

OBJECTIVE: To examine the persistence of parent-reported social-emotional and behavioral problems in infants and toddlers. METHOD: The sample comprised 1,082 children ascertained from birth records. Children were 12 to 40 months old in year 1 (1998-1999) and 23 to 48 months old in year 2 (1999-2000). Eighty percent participated in year 1 and 91% were retained in year 2. Social-emotional and behavioral problems were measured by high scores (> or=90th percentile) on the Internalizing, Externalizing, and/or Dysregulation domains of the Infant-Toddler Social and Emotional Assessment (ITSEA). Parents reported on sociodemographic factors, family life impairment, parenting stress, and family functioning. RESULTS: Among children with any high ITSEA domain score in year 1, 49.9% had persistent psychopathology, as indicated by the continued presence of a high score in year 2. In multivariate analyses, persistence was significantly more likely when parents reported co-occurring problems (i.e., problems in multiple ITSEA domains), high family life disruption, and high parenting distress in year 1. Homotypic persistence rates (i.e., same domain persistence) ranged from 38% to 50%. Only for dysregulation was homotypic persistence greater when co-occurring problems were present than for dysregulation alone. Persistence patterns were similar for boys and girls. CONCLUSION: Findings indicate that infant-toddler social-emotional/behavioral problems are not transient and highlight the need for early identification, multidomain and family assessment, and effective early intervention.

Affective Symptoms↗
PubMed2005

Defining the "disruptive" in preschool behavior: what diagnostic observation can teach us.

This paper presents the clinical/developmental framework underlying a new diagnostic observational tool, the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). The special importance of observation for clinical assessment during the preschool period is delineated. The developmental rationale for a multi-dimensional assessment of disruptive behavior in young children, including problems in modulation of negative affect and low competence is discussed. The ways in which the DB-DOS will elucidate distinctions between normative and atypical behavior during this developmental period via (a) the integration of qualitative and quantitative dimensions of behavior within a clinically-sensitive coding system, (b) the observation of child behavior both within, and outside of, the parent-child context and (c) the use of specially designed tasks to "press" for clinically salient behaviors are addressed. The promise of this new method for yielding a more precise, developmentally based description of the phenotype of early onset disruptive behavior problems and for providing a standardized clinical tool for observational assessment of disruptive behavior in young children is presented. Large-scale validation of the measure is currently underway.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed2004

Parent identification of early emerging child behavior problems: predictors of sharing parental concern with health providers.

OBJECTIVES: To better understand the predictors of parental discussions with pediatric care providers (pediatricians, psychologists/psychiatrists, social workers, early intervention providers, or other medical specialists) regarding early child behavior problems and to suggest strategies for eliciting early identification from parents in health care settings. DESIGN: A cross-sectional survey of parents of children from a representative healthy birth cohort. The survey included the Infant-Toddler Social Emotional Assessment, measurement of parental worry regarding problematic behavior, and demographic factors. SETTING: Fifteen urban and suburban towns in the northeastern United States. PARTICIPANTS: The study sample consisted of all parents of 11- to 39-month-olds (n = 269) who exceeded the 90th percentile on 1 or more Infant-Toddler Social Emotional Assessment problem domain scores (representing elevated problematic behavior symptoms) from an original sample of 1278. RESULTS: Few parents (17.7%) who reported elevated problematic behavior spoke to a provider about such problems. In adjusted models, speaking to a provider was associated with reported worry about behavior (odds ratio [OR], 3.47 [95% confidence interval (CI), 1.74-6.92]) and with low reported child social-emotional competence (OR, 2.68 [95% CI, 1.23-5.84]). In adjusted models, worry was most likely among parents who reported low child competence (OR, 2.18 [95% CI, 1.07-4.22]) and disruption in family routines attributed to the child's behavior (OR, 2.38 [95% CI, 1.31-4.33]). CONCLUSIONS: Parental worry is a robust predictor of help seeking among parents of children with behavioral problems. Further, lags in social competence contribute to both parental worry and help seeking. These findings, in conjunction with previous evidence that child behavior problems amenable to early intervention are often unidentified, suggest that systematic inquiry by health care providers about parental concerns is important in the identification of early emerging behavioral health problems.

Adult↗
PubMed2004

Assessment of young children's social-emotional development and psychopathology: recent advances and recommendations for practice.

In this paper we have tried to document some of the recent advances in the conceptualization and assessment of early-emerging social-emotional and behavior problems, competencies, and psychopathology. Considerable evidence documents that young children evidence significant psychopathology (cf., Del Carmen & Carter, in press; Emde, 1999; Zeanah, 2001; Zeanah et al., 1997). Given the range of new assessment measures that have become available over the past 10 years, the field of young child mental health is poised for dramatic gains in knowledge. It is critical to conduct large-scale, longitudinal, epidemiological studies to inform our understanding of the course of psychopathological conditions within the context of a normative developmental framework. Multi-method, multi-informant assessment approaches are more essential in early childhood due to young children's inability to provide self-reports and the embedded nature of children's development in their caregiving contexts. Screening large representative samples affords the opportunity to ascertain unbiased clinically informative sub-samples for methodologically intensive sub-studies. These sub-studies can address the child's cognitive and linguistic developmental capacities as well as utilize observational methods to examine the relational context. This approach provides an opportunity to merge dimensional and diagnostic assessments and will yield critical information for disentangling continuities and discontinuities in normative and atypical development. The assessment methodology currently exists to routinely screen very young children for social-emotional and behavior problems as well as delays in the acquisition of competencies in pediatric settings as well as in early intervention programs. Yet, despite the likely long-term benefits and cost-saving potential of early identification and intervention services, short-term cost and knowledge barriers currently limit widespread implementation. Discussions with pediatricians suggest that one of the greatest barriers to screening is the limited availability of mental health referral sources. Indeed, very few children who are rated by parents as having elevated social-emotional and behavior problems are receiving any behavioral health services (Horwitz et al., in press). Unmet mental health needs exist among non-referred children in the community as well as among children receiving early intervention services for developmental concerns. Documenting the mental health needs of young children may promote training of professionals who have the competence to treat young children and their families. Moreover, the availability of social-emotional and behavior problem assessment tools should increase studies that focus on the clinical efficacy and effectiveness of prevention and early intervention programs designed to promote positive mental health. Finally, although significant progress is occurring in the arena of young child diagnosis, a strong case can be made for intervening when young children are exhibiting elevations in problem behaviors or delays in the acquisition of competence. This is particularly true when children are also experiencing exposure to multiple contextual risk factors. It is therefore important to advocate for changes to systems that require child diagnosis as a gateway to intervention. As we learn more about the precursors or prodromal manifestations of clinical psychopathology we will be able to examine the efficacy of earlier targeted preventive intervention approaches.

Affect↗
PubMed2004

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

OBJECTIVE: To examine the reliability and validity of the 42-item Brief Infant-Toddler Social and Emotional Assessment (BITSEA), a screener for social-emotional/behavioral problems and delays in competence. METHOD: Parents in a representative healthy birth cohort of 1,237 infants aged 12 to 36 months completed the Infant-Toddler Social and Emotional Assessment (ITSEA)/BITSEA, the Child Behavior Checklist (CBCL)/1.5-5, the MacArthur Communication Developmental Inventory vocabulary checklist, and worry questions. In a subsample, independent evaluators rated infant-toddler behavior. RESULTS: Test-retest reliability was excellent and interrater agreement (mother/father and parent/child-care provider) was good. Supporting validity, BITSEA problems correlated with concurrent evaluator problem ratings and CBCL/1.5-5 scores and also predicted CBCL/1.5-5 and ITSEA problem scores one year later. BITSEA measures of competence correlated with concurrent observed competence and predicted later ITSEA competence measures. Supporting discriminant validity, only 23% of high BITSEA problem scorers had delayed vocabulary. Moreover, the combined BITSEA problem/competence cutpoints identified 85% of subclinical/clinical CBCL/1.5-5 scores, while maintaining acceptable specificity (75%). CONCLUSIONS: Findings support the BITSEA as a screener for social-emotional/behavioral problems and delays in social-emotional competence.

Child Behavior Disorders↗
PubMed2003

The Infant-Toddler Social and Emotional Assessment (ITSEA): factor structure, reliability, and validity.

In this paper the refinement and psychometric properties of the Infant-Toddler Social and Emotional Assessment (ITSEA) are described. Results from a sociodemographically diverse birth cohort sample of 1,235 parents of children between the ages of 12 and 36 months are presented. Confirmatory factor analyses supported the hypothesized Internalizing, Externalizing, Regulatory, and Competence domains as well as the 17 individual scales that comprise the ITSEA. Findings for 3 additional indices useful in identifying significant psychopathology are presented. Subgroup analyses revealed structural invariance and expected mean level differences across both child sex and 6-month age bands. Child sex differences emerged for some problem and most competence scales, with boys rated as higher on Activity/Impulsivity and girls rated higher on Anxiety and most Competence scales. All competence scores increased across age groups. Problem behaviors showed a more mixed developmental pattern. Test-retest and interrater reliability were acceptable. Associations between the ITSEA and independent evaluator ratings and parental ratings of child behavior problems, temperament, and parental distress support the validity of the instrument.

Affect↗
PubMed2003

Language delay in a community cohort of young children.

OBJECTIVE: To document the prevalence of expressive language delay in relation to age and gender in 12- to 39-month-old children. To document the characteristics, particularly social competence and emotional/behavioral problems, related to deficits in expressive language. METHOD: Parents of an age- and sex-stratified random sample of children born at Yale New Haven Hospital between July 1995 and September 1997 who lived in the New Haven Meriden Standard Metropolitan Statistical Area were enrolled when their children were 12 to 39 months of age (79.8% participation;N = 1,189). The main outcome for these analyses is expressive language delay measured by the MacArthur Communicative Development Inventory, short forms. RESULTS: Expressive language delays range from 13.5% in 18- to 23-month-olds to 17.5% in children 30 to 36 months of age. By 18 to 23 months, children are more likely to experience delays if they come from environments characterized by low education, low expressiveness, poverty, high levels of parenting stress, and parents who report worry about their children's language problems. When social competence is adjusted for in the multivariable model, behavior problems are no longer associated with language delay, suggesting that poor social competence rather than behavior problems may be the critical early correlate of low expressive language development. CONCLUSIONS: Expressive language delays are prevalent problems that appear to be associated with poor social competence. Given that such problems may be risk factors for social and emotional problems, early identification is critical.

Catchment Area, Health↗
PubMed2003

Persistence of psychiatric disorders in pediatric settings.

OBJECTIVE: To examine the longitudinal course of subthreshold and full-criteria child psychiatric disorders. METHOD: Nine hundred ninety-six children, aged 4 to 9 years, from a representative sample of pediatric primary care practices participated in a 1-year follow-up in 1989-1990. Parent interviews included the Diagnostic Interview Schedule for Children, measures of psychosocial problems, stress, social support, possible child abuse, and sociodemographics. RESULTS: The initial prevalence of full and subthreshold disorders was 18.8% and 14.0%, respectively. Full and subthreshold disorders were associated with impairment. Approximately 37% of children with full disorders had persistent disorders. Persistence was more common among boys than girls, particularly when comorbidity was present. Children with initial subthreshold disorders only were five times more likely than those without disorder to develop a full disorder. Persistence of full disorders was associated with high initial symptoms. Among boys, persistence was linked to possible child abuse, whereas among girls it was associated with full externalizing disorders that were accompanied by subthreshold internalizing disorders. CONCLUSIONS: Intervention may be particularly crucial when a high number of symptoms and/or both internalizing and externalizing problems are present. Underscoring the importance of family-centered rather than child-centered interventions, boys whose parents reported possible child abuse were more likely to have persistent disorders.

Child↗
PubMed2003

Do needs drive services use in young children?

OBJECTIVE: To determine whether different factors predicted parental recognition of mental health problems in children and use of services for those problems and to determine whether mental health problems elicit service use in the same way as physical health or developmental problems. METHODS: Survey of the parents of an age- and sex-stratified random sample of children who were born in 1 Connecticut hospital selected from state birth records. RESULTS: Logistic regression results demonstrate that a number of child and family factors are related to problem recognition, defined as thinking about seeking services and/or talking to a professional about a problem. However, factors related to the third outcome of interest-service use-are more limited and include only physical health and developmental problems, parental worry about language, and family conflict. Furthermore, mental health problems were not discussed with professionals, and they were not associated with receipt of services at the same rates as physical health or developmental problems. CONCLUSIONS: The correlates of problem recognition (defined as thinking about seeking services or actually speaking to a professional about a problem) differ from those of service use, and, whereas mental health, physical health, and developmental problems all affect problem recognition, mental health problems do not result in service use. Furthermore, rates of service use vary dramatically across the 3 categories. These results suggest that needs alone do not drive service use. Rather, other factors may influence which needs are met.

Attitude to Health↗
PubMed2002

The social-emotional development of "late-talking" toddlers.

OBJECTIVE: To examine the social-emotional problems and competencies of toddlers who evidenced lags in expressive language without concomitant receptive language delays. METHOD: Maternal report and observation of 14 "late-talking" toddlers was compared with that of 14 control toddlers. Participants were selected on the basis of maternal report of vocabulary production with the MacArthur Communicative Development Inventory Short Forms and by direct assessment with the Mullen Scales of Early Learning. Social-emotional functioning was assessed with the Infant-Toddler Social and Emotional Assessment, the Child Behavior Checklist 1.5-5, and the Vineland Adaptive Behavior Scales-Expanded Form. Toddler affect was observed using the Parent-Child Early Relational Assessment. The Parenting Stress Index Short Form was used to assess maternal stress. RESULTS: Late talkers were rated higher in depression/withdrawal and lower in social relatedness, pretend play/imitation, and compliance on the Infant-Toddler Social and Emotional Assessment and more withdrawn on the Child Behavior Checklist than controls. Observation indicated late talkers were more serious, more depressed/withdrawn, and less interested in play. Late talkers were reported to be lower in socialization on the Vineland. Mothers of late talkers endorsed higher parent-child dysfunction on the Parenting Stress Index. No differences were found for externalizing behaviors or peer relationships. CONCLUSIONS: Early lags in expressive language are associated with poor social-emotional adjustment. Intervention may ameliorate difficulty in linguistic and social-emotional functioning.

Affect↗