title: Reliability and validity of the brief behavioral distress scale: a measure of children's distress during invasive medical procedures.
abstract: OBJECTIVE
  To evaluate the reliability and validity of a new observational measure of children's procedure-related distress behaviors, the Brief Behavioral Distress Scale (BBDS), to provide clinicians with an efficient, economical alternative measure that does not depend on continuous interval coding.
  
  
  METHODS
  Forty-eight randomly selected videotaped invasive medical procedures performed on children (ages 2 to 10 years) with chronic illness were coded with the BBDS and the Observation Scale of Behavioral Distress (OSBD). Reliability and validity analyses along with item analysis were conducted.
  
  
  RESULTS
  Total distress scores of the BBDS were highly correlated with six of seven concurrent validity measures from multiple sources (i.e., OSBD, parent ratings, two nurse ratings, child self-report, and a physiological arousal measure, heart rate) (range r =.57-.76, p <.001-.0001). A robust association was found between the BBDS distress scores and OSBD total distress scores (r =.72, p <.0001). For two concurrent validity measures, the BBDS demonstrated stronger associations than did the OSBD. Interrater reliability was high for each BBDS distress behavior category.
  
  
  CONCLUSIONS
  Based on the findings reported, the BBDS is a reliable and valid measure of children's procedure-related distress with functional utility in both research and clinical settings.
authors.affiliation: Kennedy Krieger Institute, Baltimore, MD 21205, USA. tuckerc@kennedykrieger.org
authors.forename: C L
authors.initials: CL
authors.lastname: Tucker
authors.forename: K J
authors.initials: KJ
authors.lastname: Slifer
authors.forename: L M
authors.initials: LM
authors.lastname: Dahlquist
mesh_terms: D000223:Adaptation, Psychological; D001143:Arousal; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010552:Personality Assessment / Q000706:statistics & numerical data*; D012803:Sick Role; D013812:Therapeutics / Q000523:psychology*