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Journal of Pediatric Psychology, Vol. 26, No. 8, 2001, pp. 513-523
© 2001 Society of Pediatric Psychology

Reliability and Validity of the Brief Behavioral Distress Scale: A Measure of Children's Distress During Invasive Medical Procedures

Cindy L. Tucker, PhD1,2, Keith J. Slifer, PhD1,2 and Lynnda M. Dahlquist, PhD3

1 Kennedy Krieger Institute, 2 Johns Hopkins University School of Medicine, 3 University of Maryland Baltimore County

All correspondence should be sent to Cindy L. Tucker, Department of Behavioral Psychology, The Kennedy Krieger Institute, 707 N. Broadway, Baltimore, Maryland 21205. E-mail: tuckerc{at}kennedykrieger.org .

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.

Key words: children's pain; procedure-related distress; rating scale; invasive medical procedures.


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