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

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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

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      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].

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      While higher BITSEA/P scores suggest a higher level of behavioral and emotional problems, lower levels of BITSEA/C show a lower level of social-emotional competence. Turkish version of BITSEA was reported to be a reliable and valid instrument for screening social-emotional and behavior problems in toddlers with high internal consistencies (BITSEA/P; Cronbach’s alpha: .82 and BITSEA/C; Cronbach’s alpha: .72; Karabekiroglu et al., 2009). This inventory is a commonly used self-rated scale for measuring depressive symptomatology.

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      In line with our toddler sample findings, other large samples of 2-year-olds from the Netherlands (mostly rated by mothers) also found significantly higher BITSEA competence total scores for girls than for boys, and significantly higher problem total scores for boys than for girls (Kruizinga et al., 2012, 2013). In contrast, significant sex differences were not reported among maternal or paternal BITSEA ratings of Turkish 12–23-month-olds (Karabekiroglu et al., 2009), or in a larger nationwide study according to the primary caregivers’ rating (Karabekiroglu et al., 2013). The similarities between our BITSEA findings and the corresponding results from the two other Western countries may derive from the cultural similarities regarding gender roles and expectations.

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