Revision Of Infant And Toddler Social-evmotional Assessment And Its Standardization In The Chinese Population

Objective:To standardise《Infant Toddler social-emotional Assessment》version 2004 co-published by the Yale School of Psychology and the Department of Psychology, University of Massachusetts Boston, and to develop a Chinese version of the Assessment and establish a Chinese norm.Methodology:The assessment tools were studied and revised using a combination of quantitative and qualitative methods:1. Translation and back-translation: the assessment tools were translated followed by a back-translation. The comprehension, integrity, and accuracy of the translation were further verified through discussion sessions by the specialist;2. Culture adaptation: the assessment tools were discussed amongst the grass-roots healthcare professionals and parents of the children with regard to their comprehension and comprehensiveness, followed by a pilot testing in Wuhan region;3. Surveys: following the pilot testing, a formal survey was carried out using a stratified cluster sampling scheme, involving 14 cities in the 7 administrative districts in China; (1) Study subjects: healthy toddlers aged 12-36 months;(2) Survey tools: questionnaires on the general status of children, Chinese temperament Scale for toddlers, Children Behavioral Checklist aged 2-3 years and the Social-Emotional screening assessment for the aged of 12-36 months;(3) Survey methods: Parents of the study children were interviewed by the consistently trained interviewers;4. Statistic analyses: the data was manipulated and qualitatively analysed; the sample statistics were calculated including the means and standard deviations (SD) for the domains and scales. As well, the validity and reliability of the assessment structure were analysed using correlation analysis, the Cronbach's coefficient alpha and the Spear-Brown coefficient. Whereas confirmatory factor analysis was employed to access the structure of the assessment tools. Finally, the domain and scale scores were compared, using u-test, between the Chinese and American toddlers.Results1. The adapted Chinese version of《Social-emotional assessment for children aged 12 - 36 months》comprises a total of 146 items, containing four domains (Externalizing, Internalizing, Dysregulation, and Competence) with 19 scales. The screening was made through a comparison of the mean values and the associated boundaries2. The assessment tools are characteristic of their good measurability. The within-2-week test-retest reliability and the split-half reliability for the four domains were shown to be 0.71~0.86 and 0.82~0.90 respectively, with the Cronbach-αcoefficient being 0.80~0.88. A medium sized positive correlation was demonstrated among the first three of the four domains (r=0.36~0.61). On the other hand, a small negative correlation was noted with the domain Competence (r=-0.01~0.08). A significant positive correlation was found between the score of the problem domains and the six behavioural factors of CBCL. On the contrary, a significant negative correlation was noted with the six factors for the score of Competence domain. The confirmatory factor analysis demonstrated a good fitness for most models (GFI, AGFI, NFI, NNFI, and CFI all greater than 0.90, RMRSE < 0.10, and RMR < 0.04). These fitness statistics indicate that the structuring of the assessment tools fit the sample data well.3. The age and gender characteristics of the norm. As the toddlers grow older, they tend to have more internalizing problems and socio-emotional dysregulation. On the other hand, their separation distress tends to get alleviated, their sleepiness tends to get better and their emotional and social ability tend to be increased. The tendencies become more obvious from 18 months onwards. Boys tend to have more externalizing problems than girls, while the later group is more likely to have internalizing problems. This gender difference is getting enlarged with age increasing and it becomes more significant when the toddlers reach 24 months of age. The gender difference in capability starts to show from 12 months; the ability in compliance, attention and imitation/play is greater in girls than in boys. However, the difference in empathy and prosocial peer relations is not demonstrated until 18 months of age.4. The comparison between the Chinese and American toddlers. Compared with the American counterparts, the Chinese toddlers have higher scores for most domains and scales, but the Competence domain; the Chinese toddlers tend to have more problems in emotional domains, e.g., in aggression and resistance, depression/withdrawal, anxiety/worrying. This negative emotional difference gets more obvious as age grows. The internalizing behavior becomes'crossed'between the two groups of the toddlers at a certain point in age when it increases. With regard to Competence domain, the scale scores in compliance, attention, mastery motivation, empathy, and prosocial peer relations are lower for the Chinese toddlers compared with their American peers. Furthermore, as age grows the gap becomes wider in Competence between toddlers from the two countries. On the other hand, the American toddlers tend to have more serious separation distress problems compared with their Chinese counterparts. Conclusions1. The adapted Chinese version of the assessment tools has good validity and reliability with good representative-ness of the norm. The age and gender characteristics detected through the assessment tools in emotion and sociality are well in line with the development pattern of the toddlers, therefore the assessment tools can be used as screening tools for emotional and social development in children in Chinese cities.2. There are differences in emotional and social development between the Chinese and American toddlers; these differences are shown to be that the Chinese toddlers have elevated scale scores in certain problem domains of emotional and social development and decreased scores in competence domain. Further cross-cultural studies are needed to understand the root causes for the differences.Innovation1. Established, for the first time, the Chinese norm adapted from the American version of《Social-emotional assessment for children aged 12– 36 months》. This has fulfilled the gap in quantitative screening tools used for socio-emotional development for toddlers in China.2. Provided scientific bases for the promotion and intervention of the socio-emotional development for toddlers through cross-culture comparisons.