Reliability and validity of the brief behavioral distress scale: A measure of children's distress during invasive medical procedures

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.