CT Infant Mental Health Association

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CT Infant Mental Health Association
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CT INFANT MENTAL HEALTH ASSOCIATION

• Screening for Emotional and
• Behavioral Challenges
• in Young Children
• April 30, 2007

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Screens for Emotional and Behavioral Challenges
in Young Children

• BITSEA - Brief Infant-Toddler Social-Emotional
  Assessment
• Ages and Stages Social-Emotional
• DECA - Devereux Early Childhood Assessment
• Parent Questionnaire Screen for Environmental
  Risk

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Why Is Screening Important?

• Identify children at the earliest possible time
  so that intervention may be provided
• May be conducted in multiple environments
• Pediatric health care
• Early care and education
• Home visiting programs
• Family resource and support centers
• Provides an opportunity to start a very important
  conversation with a parent or caregiver

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Ecological Approach

• Must look broadly at
• Child health and development
• Relationship between child and parents, as well
  as other important caregivers
• Challenges in the environment which impact the
  childs development

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Ecological Approach
COMMUNITY
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Emotional and Behavioral Problems Do Not Just Go
Away!

• Emotional or behavioral problems at age 3 years
  60 psychiatric diagnosis by
  kindergarten or 1st grade.

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If We Do Not Act Now

• Need for special education
• Serious emotional disturbance
• Substance abuse
• Teen pregnancy
• School drop-out
• Violence in home and community
• Crime and
• incarceration
• Unemployment
• Abuse and neglect
• Poverty

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The Ages and Stages Questionnaires Social
Emotional Features
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Features of ASQSE

• 6, 12, 18, 24, 30, 36, 48 60 month intervals.
• Questionnaires contain between 19 (6 month) and
  33 (60 month) scored questions.
• 3-6 month administration window on either side
• Do not need to use CDOB or adjusted age for
  children born prematurely.

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Ages Stages SE

• Created as a result of a call from the field
• Developed by a multidisciplinary team at the
  University of Oregons Center on Human Development

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Important to Remember..

• The ASQ-SE is not a diagnostic tool for
  identifying children with serious social or
  emotional disorders rather it should be seen as
  an aide in identifying young children who may
  benefit from more in-depth evaluation and/or
  preventative interventions designed to improve
  their social competence, emotional competence, or
  both

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Uses if ASQ-SE

• (Screening) To help detect decisions about
  referrals for further assessment
• Monitor childs social-emotional development
• Determine information/support services families
  may need
• Bridge communication between parents and
  professionals about childs behavior

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Questionnaires Address 7 behavioral areas

• Compliance
• Communication
• Adaptive functioning
• Automomy
• Affect
• Interaction with people
• Self-regulation

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Associated Definitions

• Self-regulation Child ability or willingness to
  settle down or adjust to physiological or
  environmental conditions or stimulations
• Compliance Willingness to conform to the
  direction of others and follow rules
• Communication willingness to respond to or
  initiate verbal or nonverbal signs to indicate
  feelings, affective, or internal states

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7 Behavioral areas continued

• Adaptive Functioning ability to cope with
  physiological needs (i.e. sleeping, eating,
  elimination, safety)
• Autonomy willingness to self initiate or respond
  without guidance (i.e. moving to independence)
• Interaction with People Ability or willingness
  to respond to or initiate social responses to
  parents, other adults, and peers
• Affect ability or willingness to demonstrate his
  or her own feelings and empathy for others

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Features of ASQSE

• Written at a 4th to 5th grade reading level.
• Each questionnaire includes open-ended questions
  related to eating, sleeping, toileting.
• All intervals include question Is there anything
  that worries you about your baby (child)? If so,
  please explain.
• What things do you enjoy most about your baby
  (child)?

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Introducing the ASQSE to Parents

• This questionnaire asks questions about your
  childs social-emotional growth. Your answers
  will help me know what type of information I may
  be able to gather for you.
• Some of the questions are not very specific,
  but answer based on your feelings or opinions
  about your childs behavior

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Introducing the ASQSE to Parents

• Review response options
• Most of the time Child is performing behavior
  most of the time or too often
• Sometimes Child is performing behavior
  occasionally, but not consistently
• Rarely or Never Child is not or is rarely
  performing behavior.
• Discuss concerns option

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Administering ASQSE

• Have parents complete as independently as
  possible.
• Some questions may require some clarification
• (All intervals) Eating problems
• (18 months and older) Perseverative behaviors

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Review Questionnaires with Parent

• Discuss childs strengths and reinforce positive
  parent/child interactions.
• Discuss items that individually score 10 or 15
  points
• Discuss answers to open-ended questions
• Review score and compare to cutoffs
• Remember that cutoffs on ASQSE are very
  different from ASQ!
• Discuss (consider) Referral Considerations

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Questionable Scores?

• Have another caregiver complete ASQSE
• Gather additional Information
• Observe child
• Use a professionally administered screening tool
• Assess parent/child interactions
• Assess caregiving environment

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Possible Follow-up

• Below Cutoff
• Provide ASQSE Activities Monitor.
• Close to Cutoff
• Follow up on Concerns.
• Provide information, education and support.
  Re-administer ASQSE.
• Make Referrals as appropriate.

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Possible Follow-up

• Above Cutoff
• Refer to Child Development Infoline
• 1-800-505-7000
• Access point for
• Birth to Three
• Help Me Grow
• Preschool Special Education
• Children with Special Health Care Needs
• Link to primary health care provider

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Parent/Child InteractionsDeborah Weatherston
Kathleen BaltmanWayne State University
Merrill-Palmer Institute

• Consider parent and child contributions to
  interaction
• Areas
• Holding
• Looking
• Talking/Vocalizing
• Touching
• Emotion

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In Summary

• Screening tools can help bridge communication
  with families.
• Screening tools can assist in making referrals to
  community agencies.
• Referrals should be based on a variety of
  considerations in addition to scores.
• Developmental and social emotional issues are
  very complicated.
• Use teams to make decisions about next steps
  after screening.

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DECADevereux Early Childhood Assessment
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What is the DECA Program?

• A program that helps teachers and parents
  identify at risk and protective factors of
  children.
• A program that trains teachers and parents to
  implement strategies that focus on building
  childrens strengths.

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5 Step Program

• Collecting information on both individual
  children and the quality of the classroom.
• Administering the DECA on all children
• Summarizing DECA results utilizing both
  individual child and classroom profiles.
• Developing plans based on the assessment results
  that are implemented both in the classroom and
  the home.
• Evaluating process

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Devereux Early ChildhoodAssessment (DECA)

• Strengths-based tool that measures
• Initiative Self-Control Attachment
• Total Protective Factors
• 2. Behavioral Concerns
• Parent and Teacher Report
• Pre- and Post Test Results
• Behavioral Interventions and Supports

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Three Protective Factors

• Initiative the childs ability to use
  independent thought and action to meet his or her
  needs.
• Self-Control the childs ability to experience a
  range of feelings and express them using words
  and actions that are appropriate.
• Attachment the mutual, strong and long-lasting
  relationship between a child and significant
  adults such as parents, family members and
  teachers.

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Assessment Tools

• Devereux Early Childhood Assessment for Infants
  and Toddlers (DECA I/T)
• 1 month to 18 months
• Devereux Early Childhood Assessment (DECA) 18
  months to 5 years
• Devereux Early Childhood Assessment Clinical
  (DECA-C) 2 to 5 years