Parent report measures of infant and toddler social-emotional ...

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Family Practice, 2017, Vol. 34, No. 2, 127–137doi:10.1093/fampra/cmx003

Advance Access publication 3 February 2017

Review

Parent report measures of infant and toddler social-emotional development: a systematic reviewMaiken Pontoppidana,b,*, Nete K Nissa, Jan H Pejtersena, Megan M Julianc and Mette S Væverd

aSFI—The Danish National Center for Social Research, Copenhagen, Denmark, bUniversity of Copenhagen, Denmark, cCenter for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA and dCopenhagen University Babylab, Copenhagen, Denmark

*Correspondence to Maiken Pontoppidan, Department of Child and Family, SFI—the Danish National Centre for Social Research. Herluf Trolles Gade 11, 1052 Copenhagen, Denmark; E-mail: [email protected]

Abstract

Background. Identifying young children at risk for socio-emotional developmental problems at an early stage, to prevent serious problems later in life, is crucial. Therefore, we need high quality measures to identify those children at risk for social-emotional problems who require further evaluation and intervention.Objective. To systematically identify parent report measures of infant and toddler (0–24 months) social-emotional development for use in primary care settings.Methods. We conducted a systematic review applying a narrative synthesis approach. We searched Medline, PsychInfo, Embase and SocIndex for articles published from 2008 through September 2015 to identify parent-report measures of infant and toddler social-emotional development. Data on the characteristics of the measures, including psychometric data, were collected.Results. Based on 3310 screened articles, we located 242 measures that were screened for eligibility. In all 18 measures of infant and toddler social-emotional development were included. Ten of the measures were developed specifically for measuring social-emotional development, and eight were measures including subscales of social-emotional development. The measures varied with respect to, e.g. the time of publication, number of items, age span, cost and amount of psychometric data available.Conclusions. Several measures of infant and toddler social-emotional development have been developed within the last decade. The majority of psychometric data are available through manuals, not peer-reviewed journals. Although all measures show acceptable reliability, the most comprehensive and psychometrically sound measures are the Ages and Stages Questionnaires: Social-Emotional—2, Infant-Toddler Social and Emotional Assessment, Brief Infant-Toddler Social and Emotional Assessment and Child Behaviour Checklist 1½—5.

Keywords: Child, child development, infant, paediatrics, psychometrics, social skills.

Introduction

Substantial evidence has shown that young children can suffer from psychopathological conditions such as eating, sleeping, and

regulatory disorders (1–6) and that unfavourable conditions early in life may cause serious lifelong problems (7–14). Physical aggres-sion (15) and behaviour problems (16) are present in 12-month-old

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children, and 16–18% of 18-month-old children show mental health problems according to the Diagnostic Classification Zero to Three (DC 0–3) and International Classification of Diseases (ICD-10) (2). To identify young children at risk for social-emotional problems who require further evaluation and intervention, we need high qual-ity measures.

Psychopathology in infants and toddlers (defined in this article as children ages 0–24 months old) is often found within the social-emotional domains (3) and tends to persist over time (3,4,15,16). As social-emotional skills form the foundation for later function-ing in school and for building lasting relationships with friends and family, the need to assess such skills in young children is now widely accepted (1,8,17–28). Social-emotional development (SED) is defined here as ‘a child’s developing capacity to (i) experience, man-age and express the full range of positive and negative emotions; (ii) develop close, satisfying relationships with other children and adults; and (iii) actively explore their environment and learn.’ (17,29)

Infant and toddler SED is challenging to measure, mainly because the first years in a child’s life are characterized by rapid and dramatic changes across all developmental domains. Distinguishing between deviant and typical development is difficult, because deviant behav-iour exists on a continuum with typical behaviours, and most young children exhibit some challenging behaviours (e.g. tantrums, eating difficulties) (4). Therefore, measuring SED becomes more of a ques-tion of evaluating whether or not the problem behaviours limit the functioning of the child (e.g. with reduced or heightened intensity, duration and/or frequency) (1).

As SED in the first years of life primarily occurs within the context of the infant-parent relationship, parent-report measures are relevant when assessing infant SED (30). Several parent-report instruments for measuring young children’s SED are being used in practice today, such as Parents’ Evaluation of Developmental Status (PEDS) and the Ages and Stages Questionnaire (ASQ-3) (31,32). Although the qual-ity of parent-report rating scales is debated, it has notably improved over time (18,33). Observational measures are often considered more accurate, as they are filled out by professionals independently of parents. For infants and toddlers, however, the use of observational measures is difficult, because young children are very susceptible to contextual changes and are more influenced by the testing situation itself than older children (18,30,33). A major advantage of parent-report measures is that they draw on the extensive knowledge parents have about their infant across context and time (33–35).

The use of parent-report measures significantly increases the detection of developmental delays in young children in early child care settings (36–38), and routine screening is recommended by the American Academy of Pediatrics at ages 9, 18 and 24 to 30 months; however, routine screening has been difficult to implement (13,32,39–41). One reason is that, as paediatric clinicians point out, selecting appropriate measures is challenging (40). While the avail-ability of high-quality measures is crucial, measures must also be feasible for routine use in community contexts (42).

Although research on the assessment of young children exists (1,18,28,31,33,39,43–46), we found no up-to-date systematic review of available parent-report measures of infant and toddler SED. Systematic reviews aim to systematically search for, appraise, and synthesize research evidence in a transparent way (47). The aim of this article was to conduct a systematic review with a nar-rative synthesis approach, based on a comprehensive literature search of parent-report measures of SED in infants and toddlers aged 0–24 months that can be used in primary care settings and in research.

Methods

Search strategyThis review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We did not register a protocol for this study. An information specialist searched the databases in October 2013 and updated the searches in September 2015. We searched Medline, PsychINFO, Embase and SocIndex for articles that reported using specific measures of young child development. The search terms were conjunctions in the following terms: child*, baby, babies, infant*, toddler*, develop*, assessment, inventory, questionnaire*, screen, screening, scale*, instrument*, validation and validity. The search was narrowed by the following strategies: MeSH descriptors or subject headings, proximity operators, limitations of searches to title and abstracts, and articles published from 2008. Year limitation applied only to the article search; there was no age limit for the measures. The year 2008 was the starting point, as several reports on assessment meas-ures were published that year (43,45,48). In addition to the database searches, we also searched Google, Google Scholar, and publishers’ websites. For all included measures, we performed an additional search for articles with psychometric properties. All screening was performed in EPPI-Reviewer 4.

Measure selectionScreening was performed in two steps: First, abstracts and titles were screened for locating articles using a measure of development for young children. These articles were retrieved in full text and screened by one person (the first or second author, hereafter referred to as MP and NN). Names of relevant measures were added to a list. Second, all measures were screened for eligibility by both MP and NN. Any uncertainties were discussed with a third reviewer.

A measure was included if it met all of the following inclusion cri-teria: (i) It was a parent-report rating scale; (ii) it was aimed at meas-uring infant or toddler SED; (iii) it could be used with children aged 0 to 24 months; (iv) it had data on validity and reliability; (v) it was available in English; (vi) it was developed in a western country; (vii) it was commercially or otherwise available for use; and (viii) it could be obtained as a free copy for review. Furthermore, the measure should include at least one item within each of the following domains: (a) experience, manage, and express the full range of positive and negative emotions, (b) develop close, satisfying relationships with other chil-dren and adults and (c) actively explore their environment and learn.

Data extractionMP and NN performed the data extracting using a structured data extraction sheet. For each measure we extracted the following infor-mation based on available manuals, technical reports, journal arti-cles, and reports: number of domains, age range, year of publication, administration time, number of items, response categories, propor-tion of strength-based or problem-based items, size of norm sample, cost, and psychometric properties. Psychometric properties involved test-retest, Cronbach’s alpha, inter-rater reliability, sensitivity/speci-ficity, receiver operating characteristic (ROC) curves, validity, factor analysis, Item Response Theory modelling (IRT), and differential item functioning (DIF).

Results

The literature search yielded a total of 3310 articles, 313 of which mentioned the use of a measure of development for young children.

128 Family Practice, 2017, Vol. 34, No. 2

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We were able to retrieve 263 (84%) articles in full text; for the majority of the remaining articles, we were able to extract the names of the measures in the abstract. The screening of the 313 articles yielded 242 unique measures of child development. A total of 18 measures met the inclusion criteria. A flow diagram of study inclu-sion appears in Figure 1.

The most common reasons for excluding measures were that the measure was not parent-report, that it could not be used with chil-dren younger than 24 months, or that it was developed for assess-ing specific areas, such as autism or temperament. The 18 measures were divided into two groups: (1) Those developed specifically for measuring SED (hereafter called ‘SED measures’), and (2) Those that, while developed for measuring a broader construct, included at least one subscale measuring SED (hereafter called ‘SED subscale measures’). The measures appear in alphabetical order in Tables 1 and 2. As the measures in the first group were the primary focus of the article, they are presented in more detail than those in the second group. Moreover, as psychometric data are mostly provided for the entire scale and not for subscales, we do not present psychometric properties of the specific SED subscales.

The 10 SED measures are (i) Ages and Stages Questionnaires: Social-Emotional—2 (ASQ:SE-2) (49,50), (ii) Baby Pediatric Symptom Checklist (BPSC) (51) and Preschool Pediatric Symptom Checklist (PPSC) (52), (iii) Brief Infant-Toddler Social and Emotional Assessment months (BITSEA) (53–55), (iv) Child Behavior Checklist 1½—5 (CBCL) (56), (v) Devereux Early Childhood Assessment for Infants and Toddlers (DECA-I/T) (57,58), (vi) Early Childhood Screening Assessment (ECSA) (59), (vii) Greenspan Social-Emotional Growth Chart (SEGC) (60), (viii) Infant-Toddler Social and

Emotional Assessment (ITSEA) (61,62), (ix) Merrill-Palmer-Revised Scales of Development (M-P-R)—Social-Emotional (63) and (x) Social-Emotional Assessment/Evaluation Measure (SEAM™) (64,65).

The eight SED subscale measures are (i) Adaptive Behavior Assessment System, 3rd Ed. (ABAS-3) (66), (ii) Child Development Inventories (CDI) (67), (iii) Child Development Review (CDR-PQ) (68), (iv) Child Development Review – Infant Development Inventory (IDI) (68), (v) Developmental Profile 3 (DP-3) (69), (vi) Communication and Symbolic Behavior Scales Developmental Profile—Infant-Toddler Checklist (CSBS-DP) (70,71), (vii) Parents’ Evaluation of Developmental Status (PEDS) (72) and (viii) PedsQL Infant Scales—pediatric quality of life inventory (73).

We now highlight some of the differences between the measures that may have consequences for the choice of measure, depending on the primary aim for using the measure.

Publication timeSeven of the 10 measures were either published or revised within the last five years. The remaining three were published or revised within the last 10 to 15 years. The CBCL (published in 1982) is the oldest measure, and SEAM (published in 2014) is the newest.

LengthWhile the majority of the SED measures are relatively short (12–42 items) and can be completed in less than 10 minutes, two are sig-nificantly longer: the CBCL (99 items) and ITSEA (166 items). The shorter measures may be preferable for early screening, because they minimize the burden on staff and families (31,42,74). If concern

Figure 1. Flow diagram for study selection process

Measures of infant and toddler social-emotional development 129

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Tab

le 1

. C

har

acte

rist

ics

of

soci

al-e

mo

tio

nal

dev

elo

pm

ent

(SE

D)

mea

sure

s

Mea

sure

ASQ

:SE

-2B

ITSE

AB

PSC

/PPS

CC

BC

LD

EC

A-I

/TE

CSA

ITSE

AM

-P-R

SEA

MSE

GC

Com

men

tsSh

ort

vers

ion

of

ITSE

APa

rt o

f th

e Su

r-ve

y of

Wel

lbei

ng

of Y

oung

Chi

l-dr

en (

SWY

C)

Part

of

the

ASE

BA

4 it

ems

sc

reen

for

de

pres

sion

in

pare

nt. A

new

sh

orte

r ve

r-si

on is

bei

ng

deve

lope

d

A p

art

of t

he

Mer

rill-

Palm

-er

-Rev

ised

(M

-P-R

)

Dom

ains

Self

-reg

ulat

ion,

co

mpl

ianc

e,

com

mun

icat

ion,

ad

apti

ve

beha

viou

rs,

auto

nom

y,

affe

ct, a

nd

inte

ract

ion

wit

h pe

ople

Inte

rnal

izin

g,

Ext

erna

lizin

g an

d D

ysre

gula

tion

, au

tism

spe

ctru

m

diso

rder

s, o

ther

ps

ycho

path

olog

ies,

so

cial

-em

otio

nal

com

pete

ncie

s

BPS

C: I

rrit

abil-

ity,

Infl

exib

ility

an

d D

iffic

ulty

w

ith

Rou

tine

s PP

SC:

Ext

erna

lizin

g,

Inte

rnal

izin

g,

Att

enti

on

Prob

lem

s, a

nd

Pare

ntin

g C

hal-

leng

es.

Inte

rnal

izin

g,

Ext

erna

lizin

g, T

otal

Pr

oble

ms,

Em

otio

nally

R

eact

ive,

A

nxio

us/D

epre

ssed

, So

mat

ic C

ompl

aint

s,

Wit

hdra

wn,

Sle

ep

Prob

lem

s, A

tten

tion

Pr

oble

ms,

Agg

ress

ive

Beh

avio

ur, D

epre

ssiv

e Pr

oble

ms,

Anx

i-et

y Pr

oble

ms,

Aut

ism

Sp

ectr

um P

robl

ems,

A

tten

tion

D

efici

t/H

yper

acti

vity

Pr

oble

ms,

Opp

osit

iona

l D

efian

t Pr

oble

ms.

1–18

mon

ths:

In

itia

tive

and

A

ttac

hmen

t. 18

–36

mon

ths:

In

itia

tive

, At-

tach

men

t an

d Se

lf-r

egul

atio

n

Non

eE

xter

naliz

ing,

In

tern

aliz

ing,

D

ysre

gula

tion

, (p

robl

em d

omai

ns)

and

Com

pete

nce.

It

em c

lust

ers:

M

alad

apti

ve,

Aty

pica

l, an

d

Soci

al R

elat

edne

ss

Non

eC

hild

par

tici

pate

s in

he

alth

y in

tera

ctio

ns,

Chi

ld e

xpre

sses

a

rang

e of

em

otio

ns,

Chi

ld r

egul

ates

soc

ial-

em

otio

nal r

espo

nses

, C

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beg

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to s

how

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path

y fo

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hers

, C

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and

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ges

wit

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, C

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exp

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gs (

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/de

mon

stra

tes

in

depe

nden

ce

(tod

dler

s), C

hild

di

spla

ys a

pos

itiv

e

self

-im

age,

Chi

ld

regu

late

s ac

tivi

ty le

vel,

Chi

ld c

oope

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s w

ith

daily

rou

tine

s an

d re

ques

ts, C

hild

sho

ws

a ra

nge

of a

dapt

ive

skill

s

Non

e

Age

s1–

72 m

onth

s12

–35

mon

ths

1–65

mon

ths

18–6

0 m

onth

s1–

36 m

onth

s18

–60

mon

ths

12–3

5 m

onth

s1–

78 m

onth

s2–

64 m

onth

s0–

42 m

onth

sV

ersi

ons

91

21

21

11

31

Publ

ishe

dA

SQ:S

E 2

002,

A

SQ:S

E-2

201

520

06, r

evis

ed

2011

2012

1982

, rev

ised

200

020

07, r

evis

ed

2011

2010

2006

, rev

ised

201

120

0420

1420

04

Adm

inis

trat

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me

Les

s th

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7 m

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6–7

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inut

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min

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inut

esL

ess

than

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min

utes

Item

s fo

r 0–

24

mon

ths

16–3

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12 (

BPS

C),

18

(PPS

C)

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–36

4016

612

3535

Res

pons

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tego

ries

3 (F

requ

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)3

(A

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/Fre

quen

cy)

3 (F

requ

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)3

(Agr

ee)

5 (F

requ

ency

)3

(Fre

quen

cy)

3 (A

gree

/Fre

quen

cy)4

(Fr

eque

ncy)

4 (A

gree

)5

(Fre

quen

cy)

Stre

ngth

s- o

r

prob

lem

- ba

sed

Prim

arily

st

reng

ths-

base

d 65

%

Prim

arily

pr

oble

m-b

ased

74

%

Prob

lem

-bas

ed

100%

Prob

lem

-bas

ed

100%

Stre

ngth

s-

base

d 10

0%Pr

oble

m-

base

d 10

0%Pr

imar

ily

prob

lem

- ba

sed

72%

Stre

ngth

s-

base

d 10

0%St

reng

ths-

base

d

100%

Stre

ngth

s-

base

d 10

0%


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Mea

sure

ASQ

:SE

-2B

ITSE

AB

PSC

/PPS

CC

BC

LD

EC

A-I

/TE

CSA

ITSE

AM

-P-R

SEA

MSE

GC

Nor

m s

ampl

e16

,424

600

405

(BPS

C),

817

(PPS

C)

700

US

sam

ple,

344

6 m

ulti

cult

ural

sam

ple.

2183

(98

7

infa

nts

and

1196

tod

dler

s)

279

600

1,40

02,

201

456

0.89

(1–

3 w

eeks

)Pr

oble

m s

cale

: 0.

87, C

ompe

-te

nce

scal

e: 0

.85

(10–

45 d

ays)

PPSC

: 0.7

5.0.

85 (

0.68

–0.9

2)

8 da

ys.

0.85

–0.9

70.

81 (

10 d

ays)

.0.6

9–0.

90 (

mea

n of

44

day

s)0.

89 (

3 w

eeks

)0.9

7–0.

99

Cro

nbac

h’s

alph

aO

vera

ll: 0

.84

(0.7

1- 0

.87)

Prob

lem

sca

le:

0.80

, Com

pete

nce

scal

e: 0

.69

BPS

C: 0

.64–

0.

83, P

PSC

: 86

–0.9

2,

Dom

ains

: 0.6

6–0.

92,

tota

l sco

re: 0

.95

0.9–

0.95

;0.

91.

Ext

erna

lizin

g

0.66

–0.7

9;

Inte

rnal

izin

g 0.

85 (

0.52

–0.7

3),

Dys

regu

lati

on 0

.86

(0.6

2–0.

83),

C

ompe

tenc

e 0.

56–0

.79.

Ove

rall

0.93

(0

.90–

0.94

)0.

9–0.

91O

vera

ll 0.

90

(0.8

3–0.

94)

Inte

r-ra

ter

relia

bilit

y0.

91Pa

rent

: 0.6

1–0.

68,

Pare

nt-t

each

er

prob

lem

sca

le

0.28

, com

pete

nce

scal

e 0.

59

Pare

nt: 0

.61;

Te

ache

r: 0

.65;

pa

rent

-tea

cher

: 0.4

0.

0.68

–0.7

4Pa

rent

: 0.4

3–0.

79Te

ache

r: 0

.32–

0.95

Val

idit

yA

gree

men

t w

ith

sim

ilar

mea

sure

s 0.

81–0

.95.

Agr

eem

ent

wit

h A

SQ:S

E: 0

.55.

C

BC

L 0

.51–

0.79

. A

BA

S-II

: 0.3

9–

0.56

. Bay

ley-

III:

0.

25–0

.51

Agr

eem

ent

w

ith

BPS

C

dom

ains

. A

SQ:S

E

0.02

–0.5

1. P

SI

0.10

–0.4

2.

PHQ

-2:

0.02

–0.1

5.

Agr

eem

ent

wit

h

Todd

ler

Beh

avio

r

Scre

enin

g In

vent

ory

and

ITSE

A

0.48

–0.7

0.

Agr

eem

ent

be

twee

n D

EC

A a

nd

DE

CA

-T

0.83

–0.9

1.

Agr

eem

ent

wit

h C

BC

L:

0.81

. BIT

SEA

0.

60.

Agr

eem

ent

wit

h B

ITSE

A

0.57

–0.7

7. C

BC

L:

0.41

–0.6

0.

ASQ

:SE

: 0.3

4–

0.69

. Bay

ley

III:

0.

32–0

.48.

A

BA

S II

: -0

.13–

0.52

Agr

eem

ent

wit

h B

ayle

y M

enta

l Sca

le

0.79

, Bay

ley

Mot

or 0

.54.

L

eite

r-R

0.

48–0

.76)

.

Agr

eem

ent

wit

h

DE

CA

I/T

: 0.7

5;

ITSE

A: -

0.42

–0.6

5;

ASQ

: -0.

56

Agr

eem

ent

wit

h B

ayle

y II

I: 0

.18–

0.25

; W

PPSI

-III

: 0.

27–0

.53;

Pr

esch

ool L

an-

guag

e Sc

ales

-4:

0.20

–0.2

3;

PDM

S-2:

0.

06–0

.33

Sens

itiv

ity/

spec

ifici

tySe

nsit

ivit

y 0.

81,

Spec

ifici

ty 0

.84

Perc

ent

ag

reem

ent

0.83

, U

nder

-ide

ntifi

ed

0.04

, Ove

r-

iden

tifie

d 0.

13,

Posi

tive

pr

edic

tive

val

ue

0.59

Aut

ism

: sen

siti

vity

0.

72–0

.93,

Sp

ecifi

city

: 0.

76–0

.85.

Si

gnifi

cant

ly

pred

icte

d

CB

CL

/1.5

–5 a

nd

ITSE

A s

core

s on

e ye

ar la

ter.

PPSC

: Se

nsit

ivit

y 0.

75–0

.92

an

d sp

ecifi

city

0.

77 c

ompa

red

to p

aren

t

repo

rt

of d

iagn

osis

. Se

nsit

ivit

y 0.

50–0

.83

and

spec

ifici

ty 0

.82

com

pare

d to

A

SQ:S

E.

Cor

rect

ly c

lass

ified

84

% o

f a

sam

ple

of

chi

ldre

n w

ith

em

otio

nal/

beha

viou

ral

prob

lem

s. S

ensi

tivi

ty

0.85

–0.8

9 an

d

spec

ifici

ty 0

.90–

0.92

fo

r A

SD c

ompa

red

to

typi

cal d

evel

opm

ent.

Infa

nt:

Sens

itiv

-it

y 0.

27–0

.47,

sp

ecifi

city

0.

87.

Todd

ler:

Se

nsit

iv-

ity

0.41

–0.5

7,

spec

ific-

ity

0.80

–0.8

7.

Posi

tive

pre

-di

ctiv

e va

lue

0.75

–0.7

7.

Sens

itiv

ity:

0.

86,

Spec

ifici

ty:

0.83

co

mpa

red

to

diag

nose

s by

D

iagn

osti

c

Infa

nt

Pres

choo

l St

ruct

ured

In

terv

iew

(D

IPA

)

ITSE

A

sign

ifica

ntly

di

ffer

enti

ates

au

tist

ic t

oddl

ers

from

tho

se w

ith

a de

velo

pmen

tal

dela

y an

d th

ose

de

velo

ping

ty

pica

lly.

Sens

itiv

ity

0.87

, spe

cific

-it

y 0.

90

Tab

le 1

. C

on

tin

ued


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about a young child’s development is raised after the use of a brief measure, the use of a more comprehensive parent-report measure or a measure based on professional observation or interview is gener-ally recommended (75).

UsabilityFor use in primary care settings, a measure that covers a wide age range is advantageous because it reduces the need for different sys-tems. Most of the SED measures cover a wide age range, from birth to six years. Some measures consist of different versions for differ-ent ages, such as the ASQ:SE2 (nine versions) and SEAM (three ver-sions). Other measures consist of one version covering the full age range but with different items according to age, such as the M-P-R Social-Emotional and SEGC. The ITSEA and BITSEA cover the shortest age range, 12 months through 35 months. For the CBCL and ECSA, children must be 18 months or older.

Strength/problem-focusedSome of the SED measures are specifically developed within a resil-ience or strength-based framework (DECA-I/T, SEGC, M-P-R Social-Emotional and SEAM), whereas others focus on deficits, difficulties, or problems (BPSC/PPSC, CBCL and ECSA). Three measures have a mix of strengths and problem-focused items: ASQ:SE-2 (majority of strength-based items), and ITSEA and BITSEA (majority of problem-based items). Examples of strength-based items are: ‘can separate from you in familiar environment with minimal distress’ and ‘enjoys interacting with others’, whereas examples of problem-based items are ‘has trouble adjusting to changes’ and ‘hits others’.

The measures with strength-based items include domains focus-ing on positive aspects such as initiative, attachment, and empathy (e.g. SEAM and DECA-I/T), whereas the measures with problem-based items include domains focusing on problematic behaviour such as inflexibility, aggressive behaviour and attention prob-lems (e.g. CBCL and ECSA). The three measures with a mix of strength-based and problem-based items have either strength-based domains (ASQ:SE-2) or problem-based domains and a competence score (ITSEA and BITSEA). The ECSA, SEGC and M-P-R have no domains.

The two long measures, CBCL and ITSEA, include several items measuring more pathological development, such as ‘too much play-ing with own sex parts’ and ‘playing with own poop’. While these measures might not be ideal for first-stage screening, they are more relevant for the second-stage screening of young children for whom substantial worry exits about their SED.

Norm samplesAlthough all SED measures have norms, the size of the norming sam-ples spans 279 (ECSA) to 16,424 children (ASQ:SE-2).

PsychometricsWhile we were able to locate psychometric data on all 10 measures, the amount of data differ. Most of the psychometric information was available either through assessment guides (43–46) or the technical report part of the manual, and the remainder was available through peer-reviewed journal articles. For eight measures, we found peer-reviewed articles including psychometric data, but we did not find any for the SEGC and M-P-R. The measure with the most articles was the CBCL, the oldest measure. We also found articles on the ITSEA, BITSEA, DECA I/T and ASQ:SE-2. We found one article on the BPSC/PPSC, SEAM, and ECSA. Data from these articles may M

easu

reA

SQ:S

E-2

BIT

SEA

BPS

C/P

PSC

CB

CL

DE

CA

-I/T

EC

SAIT

SEA

M-P

-RSE

AM

SEG

C

RO

CX

xx

xFa

ctor

ana

lysi

sx

xx

xx

xx

xIR

TX

xx

DIF

Xx

Cos

t of

sta

rter

kit

$275

$286

–348

for

IT

SEA

and

B

ITSE

A c

ombi

ned

Free

$160

–375

$199

.95

Free

$286

–348

for

IT

SEA

and

BIT

SEA

co

mbi

ned

$925

for

the

fu

ll M

-P-R

$49.

95$1

15

Sour

ceM

anua

l, jo

urna

l ar

ticl

esJo

urna

l art

icle

sJo

urna

l art

icle

sM

anua

l, jo

urna

l ar

ticl

esM

anua

lJo

urna

l ar

ticl

eJo

urna

l art

icle

sM

anua

lM

anua

lM

anua

l

ASQ

:SE

-2: A

ges

and

Stag

es Q

uest

ionn

aire

s: S

ocia

l-E

mot

iona

l—2;

BPS

C: B

aby

Pedi

atri

c Sy

mpt

om C

heck

list;

PPS

C: P

resc

hool

Ped

iatr

ic S

ympt

om C

heck

list;

BIT

SEA

: Bri

ef I

nfan

t-To

ddle

r So

cial

and

Em

otio

nal A

sses

smen

t m

onth

s; C

BC

L 1

½–5

: Chi

ld B

ehav

ior

Che

cklis

t 1½

–5; D

EC

A-I

/T: D

ever

eux

Ear

ly C

hild

hood

Ass

essm

ent F

or In

fant

s A

nd T

oddl

ers;

EC

SA: E

arly

Chi

ldho

od S

cree

ning

Ass

essm

ent;

SE

GC

: Gre

ensp

an S

ocia

l-E

mot

iona

l Gro

wth

C

hart

; IT

SEA

: Inf

ant-

Todd

ler

Soci

al a

nd E

mot

iona

l Ass

essm

ent;

M-P

-R: M

erri

ll-Pa

lmer

-Rev

ised

Sca

les

of D

evel

opm

ent

- So

cial

-Em

otio

nal;

SEA

M: S

ocia

l-E

mot

iona

l Ass

essm

ent/

Eva

luat

ion

Mea

sure

; RO

C: R

ecei

ver

Ope

rat-

ing

Cha

ract

eris

tic;

IR

T: I

tem

Res

pons

e T

heor

y; D

IF: D

iffe

rent

ial I

tem

Fun

ctio

ning

; AB

AS-

II: A

dapt

ive

Beh

avio

r A

sses

smen

t Sy

stem

, 2nd

Ed.

; CD

I: C

hild

Dev

elop

men

t In

vent

orie

s; C

DR

-PQ

: Chi

ld D

evel

opm

ent

Rev

iew

; ID

I:

Chi

ld D

evel

opm

ent

Rev

iew

—In

fant

Dev

elop

men

t In

vent

ory.

Tab

le 1

. C

on

tin

ued


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Tab

le 2

. C

har

acte

rist

ics

of

soci

al-e

mo

tio

nal

dev

elo

pm

ent

(SE

D)

sub

scal

e m

easu

res

Mea

sure

AB

AS-

3C

DI

CD

R-P

QC

SBS

DP

DP-

3ID

IPE

DS

PED

S-Q

L

Com

men

tsPa

rt o

f C

hild

D

evel

opm

ent

Rev

iew

(C

DR

)

Part

of

Chi

ld

Dev

elop

men

t R

evie

w

(CD

R)

Sing

le s

cale

s ca

n be

us

ed a

s ea

ch s

cale

was

se

para

tely

nor

med

.

Part

of

Chi

ld

Dev

elop

men

t R

evie

w

(CD

R)

Subs

cale

sC

once

ptua

l; So

cial

Pr

acti

cal

Soci

al D

evel

opm

ent,

Self

Hel

p, G

ross

M

otor

, Fin

e M

otor

, L

angu

age,

Let

ters

and

N

umbe

rs, P

ossi

ble

Prob

lem

s

Soci

al, S

elf-

Hel

p,

Gro

ss M

otor

, Fin

e M

otor

, and

Lan

guag

e

Soci

al, S

peec

h an

d Sy

mbo

lic

com

posi

tes

Gen

eral

Dev

elop

men

t, Ph

ysic

al, A

dapt

ive

B

ehav

ior,

So

cial

-Em

otio

nal,

C

ogni

tive

, C

omm

unic

atio

n

Soci

al, S

elf-

Hel

p,

Gro

ss M

otor

, Fin

e M

otor

, and

Lan

guag

e

Glo

bal/C

ogni

tive

, Ex-

pres

sive

Lan

guag

e an

d A

rtic

ulat

ion;

Rec

epti

ve

Lan

guag

e; F

ine-

Mot

or;

Gro

ss-M

otor

; Beh

avio

r;

Soci

al-e

mot

iona

l; Se

lf-

Hel

p; S

choo

l; an

d O

ther

.

Phys

ical

Fun

ctio

n-in

g, P

hysi

cal S

ymp-

tom

s, E

mot

iona

l Fu

ncti

onin

g, S

ocia

l Fu

ncti

onin

g, C

ogni

-ti

ve F

unct

ioni

ng

Age

s0–

89 y

ears

18 m

onth

–5 y

ears

18 m

onth

s–5

year

s6–

24 m

onth

s0–

12 y

ears

0–18

mon

ths

0–9

year

s1–

24 m

onth

sPu

blis

hed

AB

AS-

II 2

003,

A

BA

S-3

2015

1992

1990

, rev

ised

200

520

02D

P-II

198

0, D

P-3

2007

, re

vise

d 20

1119

94, r

evis

ed 2

005

1997

1998

Adm

inis

trat

ion

tim

e20

min

utes

20 m

inut

es5

min

utes

Les

s th

an 1

0 m

inut

es20

–40

min

utes

5 m

inut

esL

ess

than

5 m

inut

esL

ess

than

10

min

utes

Tota

l Ite

ms

241

300

6 op

en e

nded

item

s +

25 +

Chi

ld d

evel

op-

men

t ch

art

2418

02

open

end

ed it

ems

+ In

fant

Dev

elop

men

t C

hart

1036

/45

Item

s in

SE

D s

ubsc

ale

4840

Tic

k ch

ild s

kills

in

char

t4

8T

ick

child

ski

lls in

ch

art

216

–17

Res

pons

e ca

tego

ries

4 (F

requ

ency

)2

(Yes

/No)

2 (Y

es/N

o)3

(Fre

quen

cy)

2 (Y

es/N

o)2

(Yes

/No)

3 (Y

es/N

o/A

litt

le)

+

com

men

ts5

(Fre

quen

cy)

AB

AS-

3: A

dapt

ive

Beh

avio

r A

sses

smen

t Sy

stem

, 3r

d E

d.;

CD

I: C

hild

Dev

elop

men

t In

vent

orie

s; C

DR

-PQ

: C

hild

Dev

elop

men

t R

evie

w;

CSB

S-D

P: C

omm

unic

atio

n an

d Sy

mbo

lic B

ehav

ior

Scal

es D

evel

opm

enta

l Pr

ofile

-

Infa

nt-T

oddl

er C

heck

list;

DP3

: Dev

elop

men

tal P

rofil

e 3;

ID

I: C

hild

Dev

elop

men

t R

evie

w -

Inf

ant

Dev

elop

men

t In

vent

ory;

PE

DS:

Par

ents

’ Eva

luat

ion

of D

evel

opm

enta

l Sta

tus;

Ped

sQL

Inf

ant

Scal

es: P

edia

tric

Qua

lity

of L

ife

Inve

ntor

y.


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be on earlier versions of the measure (e.g. the CBCL 2–3, DECA and ASQ:SE) and include ages older than two years. Most studies are based on relatively representative or typically developing sam-ples, but some studies also include clinical samples characterized by severe disability or developmental delay (SEAM, CBCL, ASQ:SE-2, PPSC/BPSC, BITSEA, SEGC and M-P-R). A few studies are based on a autism spectrum disorder sample (CBCL, ASQ:SE-2, M-P-R). Most studies use a US sample, but some include samples from other countries (CBCL, ASQ:SE-2, BITSEA, ITSEA).

Generally, the reported psychometric data are based on classi-cal test theory (such as test-retest, Cronbach’s alpha, inter-rater reli-ability) and factor analyses, with limited data based on modern test theories such as Item Response Theory (IRT) modelling. In contrast to classical test theory, IRT models emphasize formal statistical mod-els of the probabilities of item responses (76), and focus on making assessment measures efficient and precise.

Test-retest coefficients, which are reported by all but one meas-ure (SEGC), range from 0.68–0.99, while Cronbach’s alpha coef-ficients range from 0.52 to 0.95, with the majority ranging from 0.80 to 0.95. Generally, while a reliability coefficient of at least 0.70 is recommended, coefficients between 0.6 and 0.8 are common for measures of personality and other issues that are harder to measure than, for example IQ (77). All measures have acceptable reliability coefficients, with only a few coefficients below 0.6.

Six measures report inter-rater reliability data. Both father-mother, parent-teacher and teacher-teacher inter-rater reliability data are reported, ranging from 0.28 to 0.95. The samples used for calculating inter-rater reliability are generally small. Parent-teacher inter-rater reliability does not necessarily have to be high, as children can have problems in one context (e.g. school) but not in another (e.g. home). Although teacher-teacher and father-mother inter-rater reliability should be within the ranges of the other reliability coef-ficients, examples in which a mother and father have very differing perceptions of the levels of problems exhibited by their child exist. The ITSEA, BITSEA, CBCL and DECA-I/T all have coefficients that are acceptable but in the low end, whereas the ASQ:SE-2 coefficient is excellent. SEAM coefficients range from 0.32–0.95, which is from unacceptable to excellent.

All but two measures (M-P-R and SEAM) have data on pre-diction. Sensitivity/specificity data are reported for eight measures ranging from 0.27–0.93 (sensitivity) and 0.76–0.92 (specificity). ROC curves are reported for three measures. Sensitivity/specificity data and ROC curves express how well a measure correctly classi-fies a child as having problems that warrant treatment or not and are therefore critical for clinical use (78,79). To calculate prediction data, the measure under evaluation is compared to the test that is considered the gold standard within the specific area (79). Because there is no gold standard within the area of infant SED, no consensus exists for which measure to compare with for obtaining prediction data. The measures that have prediction data base the calcula-tions on, for example, parent report of diagnosis, Autism Spectrum Disorder (ASD) measures or diagnosis, samples with infants with SED problems, Diagnostic Infant Preschool Structured Interview (DIPA), DECA-I/T, ITSEA and CBCL. Sensitivity data are relatively low for DECA I/T. Its developers state that the reason as specificity being prioritized higher than sensitivity (58).

Factor analysis data are reported for all measures except SEGC and SEAM. IRT data are reported for three measures (ASQ:SE-2, M-P-R and SEAM). Differential item functioning (DIF) is reported for two measures (ASQ:SE-2 and BPSP/PPSP). DIF analyses are performed to check for any differences in the way an item functions across groups,

such as gender, age or education for a given level of the scale score, and are an important element of evaluating bias in a measure (80).

CostComparing the costs of the measures is difficult, as the time neces-sary for training the professionals differs, as do the monetary and time costs of using a web-based scoring system rather than pen-and-pencil scoring. We report the price for a starter kit, which includes a number of forms and a manual. Two of the measures are free (BPSC/PPSC and ECSA). The remaining eight have starter kits priced from $49.95 (SEAM) to $925 for the full M-P-R, which covers develop-mental areas other than SED. Most measures do not provide any information on training options. DECA and SEAM both offer a free one-hour webinar, whereas a comprehensive one-day training is available for the ASQ:SE-2.

SED subscale measuresMost of the eight SED subscale measures in Table 2 were developed in the 1980s or 1990s and the SED subscale measures are generally older than the SED measures. Three have been revised within the last 10 years, and ABAS-3 was released in 2015. Five of the SED subscale measures are relatively short (e.g. PEDS and CDR-PQ), but three are longer scales with 180 to 300 items (DP-3, ABAS-3 and CDI). Whereas all the SED measures have three to five response categories, only half of the SED subscale measures have yes/no response cat-egories. CDR-PQ and IDI stand out because they use charts instead of questions; ABAS-3, because it focuses on adaptive behaviour; PEDS-QL, because it also measures physical symptoms; and DP3 and CDI, because of their in-depth measuring.

Discussion

This systematic review identified 10 measures of infant and toddler SED and another eight parent report measures with subscales meas-uring infant and toddler SED, measures that are available for use in primary care settings and in research. In this article, we provide information that can aid in the process of choosing an SED measure. For information about implementing measures in clinical practice, see, e.g. Glascoe (38).

All of the SED measures are developed or have been thoroughly revised within the last decade, reflecting the recent focus on the SED of young children. The differences in the SED measures show that infant and toddler SED overlaps with other areas of child develop-ment, such as executive functioning (which, while viewed as a cog-nitive ability, includes areas such as self-regulation—a central part of social-emotional behaviour) (81). As Bagner et al. point out, a weakness of the SED measures is that they give limited information about the parent-child relationship (28), an important construct for assessing infant and toddler SED, and one that therefore should be measured separately.

Overall, the available published data on reliability and valid-ity appeared reasonably sound. However, as previously mentioned, most of the psychometric information came from technical reports in manuals that have not been subject to peer review. That the psy-chometric properties of the measures used in primary care settings are excellent is crucial, because they are used for making decisions about young children and their parents’ future course of treat-ment. Publishing psychometric data on measures that are commer-cially published is difficult, partly because of copyright constraints. Therefore, most of the information on the measures distributed


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through publishers is available in manuals, not in peer-reviewed journal articles. Publishing more psychometric data on measures of infant SED in peer-reviewed journals is therefore necessary.

Most SED measures (except M-P-R and SEAM) report predictive data that are crucial for a screening measure for use in clinical prac-tice. As no gold standard measure exists to compare the measures to, evaluating how well the different measures correctly predict which infants and toddlers need treatment is difficult.

All SED measures show acceptable reliability data. Based on the data available for this article, the most comprehensive and psy-chometrically sound measures were the relatively short measures ASQ:SE-2 and BITSEA, and the longer measures ITSEA and CBCL. Of the four, ASQ:SE-2 is the only measure that can be used with the entire age range of 0 to 24 months. The ITSEA and BITSEA can be used with children ages 12 to 35 months, and the CBCL can be used with children from 18 months. While the BPSC/PPSC, DECA-I/T, ECSA, and SEAM have been rigorously developed, psychometric data are few. This is probably mainly because all these measures are still relatively new (published between 2010–15). The SEGC and M-P-R both have limited sound psychometric data available.

In choosing a measure, apart from comparing costs, psycho-metric quality and the ease of use, considering the theoretical background of both the measure and the setting (families and clini-cians) is also important. Some child and family settings base their theoretical perspectives on resilience or positive psychology the-ory, and their practitioners often find it essential to measure child strengths and competencies to understand the development of the child (1,18,33,82). In such settings, using a strength-based measure (e.g. DECA I/T and SEAM) may be important. Studies have shown that competence scores predict psychiatric disorders and that young children with lower social-emotional competence scores than their peers are at risk for later social-emotional problems (83). Moreover, both teachers and parents tend to find some of the problem-focused questions irrelevant or even offensive, especially in the measures for older children (18,74). Strength-based measures may be a better fit for screening in primary care or early education settings, whereas problem-focused measures may be a better fit for clinical settings.

During the screening process of this study, we found that the available measures for school-aged children appeared to greatly out-weigh those available for children below the age of two, and there are even fewer for children below the age of one. Moreover, some measures for young children were simply downward-age extensions of measures developed for older children and therefore may not be sufficiently sensitive to the developmental problems in young chil-dren (18). With the more recent acknowledgment that mental health problems can be present in very young children, the need for high-quality measures of young children’s SED and routine use in primary care settings becomes essential. However, given the complexity of measuring young children’s development, such as the rapid develop-ment and lack of language, the use of measures with infants also calls for great caution. Although more work is still needed, the recent development shown in this paper within the field of infant and tod-dler SED measures leaves reason for optimism.

Strengths and limitationsA strength of this study is that it was built on a thorough and system-atic literature search and screening procedure for identifying avail-able measures for assessing infant and toddler SED. Another is that it offers information that can help providers identify good measures to use as part of their routine practice with young children. A limitation of the study is that we could include only the measures for which we

could obtain a free copy for review. Fortunately, in most cases we were able to obtain the copies.

Conclusion

Measuring infant and toddler SED in primary care settings is criti-cal for reliably identifying those children at risk for social-emotional problems who require further evaluation and intervention. Within the last decade, new measures have been developed and older measures have been revised, yielding a range of available measures for assess-ing the SED of children ages 0 to 24 months. Ten parent measures are specifically developed for measuring SED, and eight have subscales measuring SED. As these measures vary in many ways, they are likely to cater to different needs. The majority of psychometric data are available through manuals, not peer reviewed-journals, and are based on classical test theory and factor analysis, whereas only a few use DIF analyses and IRT. Although all SED measures show acceptable reliability data, the most comprehensive and psychometrically sound

measures appear to be the ASQ: SE-2, BITSEA, CBCL and ITSEA.

AcknowledgementsThe authors would like to acknowledge and thank information specialists Anne-Marie Klint Jørgensen and Bjørn Christian Viinholdt Nielsen for run-ning the searches.

DeclarationFunding: Danish National Board of Social Services and TrygFonden.Ethical approval: none.Conflict of interest: none.

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