Three traditional and three new childhood anxiety questionnaires: their reliability and validity in a normal adolescent sample

The current study examined the psychometrics of three traditional [i.e., the trait anxiety version of the State-Trait Anxiety Inventory for Children (STAIC), the Revised Children's Manifest Anxiety Scale (RCMAS), and the Fear Survey Schedule for Children - Revised (FSSC-R)] and three new childhood anxiety scales [the Multidimensional Anxiety Scale for Children (MASC), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Spence Children's Anxiety Scale (SCAS)] in a large sample of normal adolescents (N=521). Childhood anxiety scales were generally found to be reliable in terms of internal consistency. Furthermore, evidence was obtained for the convergent and divergent validity of the various anxiety questionnaires. That is, anxiety questionnaire scores were found to be substantially intercorrelated. Particularly strong associations were found between total scores of the STAIC and the RCMAS, total scores of the SCARED and the SCAS, and between subscales that intend to measure specific categories of anxiety symptoms. Childhood anxiety questionnaires were substantially connected to an index of depression, although correlations among anxiety questionnaires were generally higher than those between anxiety scales and a measure of depression.     

Screening for trauma in children and adolescents: the validity of the Traumatic Stress Disorder Scale of the screen for child anxiety related emotional disorders

Examined the validity of the Traumatic Stress Disorder scale of the Screen for Child Anxiety Related Emotional Disorders (SCARED), a recently developed self-report questionnaire measuring Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) defined anxiety disorders symptoms in children. A large sample of normal schoolchildren (N = 996) ages 7 to 19 years completed the SCARED. Children who scored high on the SCARED Traumatic Stress Disorder scale (i.e., trauma group; n = 43) and children who scored low on this scale (i.e., control group; n = 43) were then interviewed about their most aversive life event. In addition, children completed self-report questionnaires of traumatic experiences and posttraumatic stress disorder (PTSD) symptomatology. Results showed that children in the trauma group more frequently reported life events that independent judges considered to be 'potentially traumatic' than did control children. Furthermore, children in the trauma group reported having experienced more traumatic incidents and had higher scores on PTSD-related questionnaires compared with control children. Moreover, trauma group children more frequently fulfilled DSM-IV criteria for PTSD than did control children. The results of this study support the validity of the Traumatic Stress Disorder scale of the SCARED.     

The utility of screen for child anxiety related emotional disorders (scared) as a tool for identifying children at high risk for prevalent anxiety disorders

Abstract

The current study examined the utility of the Screen for Child Anxiety Related Emotional Disorders (SCARED) as a screening tool for the identification of children at high risk for prevalent childhood anxiety disorders. The child version of the Structured Clinical Interview for DSM (KSCID) was used as the diagnostic standard. It was investigated whether SCARED scores are indicative for the presence of generalized anxiety disorder, separation anxiety disorder, and social phobia. Five-hundred-and-thirty-seven children aged 7–14 years completed the SCARED. From this sample, 82 children were selected on the basis of their SCARED scores. A subgroup of these children scored relatively high on the generalized anxiety disorder, separation anxiety disorder, and/or social phobia scale(s) of the SCARED. A comparison group of children scored relatively low on these SCARED scales. Both groups of children then received the semi-structured interview to assess to what extent they fulfilled the DSM-IV criteria for the relevant anxiety disorders. Results provided some support for the predictive validity of the SCARED generalized anxiety disorder and separation anxiety disorder subscales. The implications of these findings for the detection of anxiety disorders in normal children are briefly discussed.     

Psychometric properties of the screen for child anxiety related emotional disorders (SCARED) among elementary school children in Finland

Anxiety disorders are the most common mental disorders in children and youth. Effective screening methods are needed to identify children in need of treatment. The Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire is a widely used tool to assess childhood anxiety. We aim toevaluate the psychometric properties of the SCARED questionnaire, test the SCARED factor structure, and evaluate the prevalence of anxiety symptoms in a community sample of Finnish elementary school children, based on both a child and parent report. The sample included all pupils (n = 1,165) in grades 2 through 6 (ages 8–13) in four elementary schools in the city of Turku, Finland. Children completed a Finnish translation of the SCARED questionnaire at school, with one parent report questionnaire per child completed at home. In total, 663 child‐parent dyads (56.9%) completed the questionnaire. Internal consistency was high for both child and parent reports on all subscales (0.71–0.92), except for school avoidance (0.57 child, 0.63 parent report). Inter‐rater reliability ranged from poor to fair across subscales (intraclass correlation 0.27–0.47). Self‐reported anxiety scores were higher than the parent reported scores. Females had significantly higher total scores than males based on the child reports (p = 0.003), but not the parent reports. In the confirmatory factor analysis, hypothesized models did not have a good fit with the data, and modification was needed. The Finnish SCARED questionnaire has good internal consistency. Low child‐parent agreement calls for the importance of including both child and parental reports in the assessment of anxiety symptoms.     

Low-end specificity of childhood measures of emotional distress: consistent effects for anxiety and depressive symptoms in a nonclinical population

Previous research regarding the low-end specificity of self-report measures of affective distress in children suggests that defensiveness acts differentially to lower scores on self-report measures of depressive symptoms, but not on self-report measures of anxiety. This investigation examined this issue in a nonclinical sample of 442 children, ages 7 to 16. Participants completed measures of depressive symptoms (Children's Depression Inventory), anxiety symptoms (State-Trait Anxiety Inventory for Children) and defensiveness (Children's Social Desirability Scale). In contrast to previous research, the results in this study indicated similar effects of defensiveness on measures of depressive symptoms and anxiety. Low-end depression participants obtained significantly higher defensiveness scores, as did low-end anxious participants. In an attempt to circumvent the effects of defensiveness, we measured anhedonia (Pleasure Scale for Children, or PSC) as a proxy of depressive symptoms. We also found the PSC to be subject to the effects of defensiveness at approximately the same magnitude as the measures of anxiety and depressive symptoms.     

Trajectories of Social Anxiety in Children: Influence of Child Cortisol Reactivity and Parental Social Anxiety

Few studies have examined the interactive effect of intra- and extra-individual vulnerability factors on the trajectory of social anxiety in children. In this study, we examined the joint influence of familial vulnerability (i.e., parental social anxiety) and child biological stress vulnerability (i.e., cortisol reactivity) on trajectories of social anxiety. Children (N?=?112 (57 males), M _age?=?8.14 years, S.D. = 2.25) were followed over three visits spanning approximately three years. Parental social anxiety was assessed using the Social Phobia and Anxiety Inventory, children’s behavior and salivary cortisol reactivity were measured in response to a speech task, and children’s social anxiety was assessed at all three visits using the Screen for Child Related Emotional Disorders (SCARED; Parent-report). A growth curve analysis was used to examine trajectories of child social anxiety as predicted by children’s cortisol reactivity and parental social anxiety, adjusting for covariates. We found a significant interaction between parental social anxiety and child cortisol reactivity in predicting child social anxiety across time. Having a socially anxious parent coupled with heightened cortisol reactivity predicted the highest levels of child social anxiety, with scores that remained above clinically significant levels for social anxiety across all visits. Children with familial risk for social anxiety and who also exhibit high stress-reactivity appear to be at risk for persistent, clinically significant social anxiety. This highlights the importance of considering the interaction between both biological and contextual factors when considering the development, maintenance, and treatment of social anxiety in children across time.     

Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients

This study examined the effects of micronutrients on children with clinically elevated stress and anxiety 23–36 months after experiencing a natural disaster (a major earthquake). A single-case multiple-baseline design allocated 14 children (7 males, 7 females; aged 8–11 years; 10 with formal anxiety-disorder diagnoses) randomly to 1, 2 or 3 week baselines. Participants then took eight capsules/day of a micronutrient formula (EMPowerplus) during an 8-week open-label trial. Assessment instruments were the Children’s Global Assessment Scale (CGAS), the Screen for Child Anxiety-Related Emotional Disorders (SCARED), the Pediatric Emotional Distress Scale (PEDS), and the Revised Children’s Manifest Anxiety Scale (RCMAS). Symptom severity declined slightly in baseline for some children and declined much more during intervention for all children. Effect sizes at end of treatment were ?1.40 (RCMAS), ?1.92 (SCARED), +1.96 (CGAS), and ?2.13 (PEDS). Modified Brinley plots revealed decreases in anxiety and improvements in overall functioning for 10 out of 11 completing participants. Side effects were mild and transient. The study provided evidence that treatment with a dietary supplement containing micronutrients reduced children’s post-disaster anxiety to a clinically significant degree. Future placebo-controlled randomized-controlled trials and treatment-comparison research is recommended to determine if this is true of anxiety in general.     

Do childhood anxiety measures measure anxiety?

The Fear Survey Schedule for Children-Revised (FSSC-R), Revised-Children's Manifest Anxiety Scale (RCMAS), and the Modified State-Trait Anxiety Inventory for Children (STAIC-M) are three widely used self-report measures of childhood anxiety. While previous studies have established the reliability of these measures, their validity in discriminating anxious from non-anxious youngsters remains to be established. The present study examines the discriminant validity of the three measures by comparing clinic referred samples of boys with an anxiety disorder (n=105) or ADHD (n=59) with a community sample of never-psychiatrically-ill boys (n=49). Results indicated that the two patient groups differed significantly from the never-psychiatrically-ill group on the RCMAS and STAIC-M, but the anxious and ADHD groups did not differ from each other. None of the three groups differed on the FSSC-R. The implications of these findings for the assessment of childhood anxiety disorders are discussed.     

Measurement of Preoperative Anxiety in Young Children: Self-report Versus Observer-rated

The utility of the self-report Children’s Anxiety and Pain Scale Anxiety subscale (CAPS-A) in comparison to the widely used, observer-rated Modified Yale Preoperative Anxiety Scale (mYPAS) in assessing anxiety in children undergoing day surgery procedures was examined. The CAPS-A test-retest reliability, concurrent validity with the Modified Yale Preoperative Anxiety Scale (mYPAS), and sensitivity to expected increases in anxiety at stressful times during the preoperative period were examined. Levels of observer-rated (mYPAS) and self-reported anxiety (CAPS-A) were obtained from 61 children (3 to 6 years) undergoing day surgery procedures. The CAPS-A demonstrated adequate test-retest reliability. Concurrent validity between the CAPS-A and mYPAS scores was poor. The CAPS-A failed to show sensitivity to the expected increases in anxiety at stressful time-points. Thus, an alternative scoring strategy for the CAPS-A was proposed (i.e., child’s refusal to point was scored as high anxiety). Post-hoc analyses demonstrated good concurrent and adequate convergent validity with the alternative scoring strategy.     

The natural course of anxiety symptoms in early adolescence: factors related to persistence

Background and objectives: Anxiety disorders are the most common mental health problems during childhood and adolescence. This study examined the course of anxiety symptoms in early adolescents from the general population over three phases.

Design: Prospective cohort study.

Methods: Two hundred and forty-two participants (mean-age of 13.52) from a baseline sample of 1514 (mean-age of 10.23) were followed up three times. Of the 1514 children, those with emotional risk and controls without risk constituted the second-phase sample (n?=?562; mean-age of 11.25). The Screen for Child Anxiety Related Emotional Disorders-SCARED was administered in all three phases.

Results: Fifty-six percent and 32% of respondents showed total scores above the SCARED cutoff point at one and three years follow-up, respectively. Eight percent showed fluctuating symptoms. Fifty-five percent of respondents showed high scores for any subtype of anxiety over three years. Social phobia and generalized anxiety symptoms were the most prevalent and persistent. Participants with persistent separation anxiety showed the highest co-occurrence with symptoms of other psychopathological disorders. Participants with persistent anxiety showed lower academic performance. Being male was a protective factor against persistence.

Conclusions: The data support anxiety maintenance during early adolescence. Early adolescence is a critical period which may involve other serious academic, social, and family problems.     

The revised version of the screen for child anxiety related emotional disorders (scared-r): Further evidence for its reliability and validity

Abstract The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R) is a self-report questionnaire that intends to measure symptoms of childhood anxiety disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1994). The current article presents three studies which examined in more detail the reliability and validity of the SCARED-R. Study 1 (N=101) demonstrated that the SCARED-R possesses satisfactory test-retest stability. Study 2 (N=71) shows that the child-parent agreement of the SCARED-R is rather low. Study 3 (N=88) provides support for the concurrent validity of the SCARED-R. More specifically, SCARED-R scores were correlated in a meaningful way with scores on the Children's Anxiety Scale, a questionnaire that also measures DSM-defined childhood anxiety symptoms.     

Children's emotion regulation: Self-report and physiological response to peer provocation

The authors examined the notion that children's emotion regulation (ER) is a uniform skill by (a) investigating the concordance between self-report of ER and physiological measures and by (b) examining ER in a specific context (e.g., peer provocation) and context-free manner (e.g., during a semistructured interview of ER abilities). Seventy-two children in middle childhood (average age = 9 years) participated. Time-locked measures of heart rate reactivity and recovery were obtained in response to provoking comments, and vagal regulation was measured throughout the provocation session. Children who reported greater dysregulation showed increased heart rate reactivity to provocative comments (i.e., steeper heart rate slope) but no difference in heart rate recovery. The context-free but not the context-specific self-report measure was associated with a failure to suppress vagal tone. Implications for ER measurement and children's peer relations are discussed.     

Confirmatory Factor Analysis of the Childhood Anxiety Sensitivity Index: A Gender Comparison

The Childhood Anxiety Sensitivity Index (CASI) is an 18-item self-report tool designed to measure the construct of anxiety sensitivity (i.e. the belief that anxiety may have harmful consequences such as sickness, embarrassment, or loss of control) in children and adolescents. Previous factor analytic examinations of the CASI have produced varied results. Gender may play a role in this observed variability. In an effort to confirm the factor structure of the measure across gender, CASI items for 671 children and adolescents were subjected to confirmatory factor analysis. Results indicated that for boys two-, three-, and four-factor structures provided a relatively good fit to the data, with the three-factor structure emerging as having the best fit overall. In contrast, for girls only the three-factor structure fitted the data well. Direct comparison of fit of the three-factor model across gender provided evidence to support the notion that childhood anxiety sensitivity is similar in structure across gender.     

Anxiety as a Predictor and Outcome Variable in the Multimodal Treatment Study of Children with ADHD (MTA)

Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were questions regarding the nature of DISC Anxiety, the impact of comorbid conduct problems on the moderating effect of DISC Anxiety, and the clinical significance of DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for DISC Anxiety, given conduct problems. In this context, exploratory analyses of baseline data suggest that DISC Anxiety may reflect parental attributions regarding child negative affectivity and associated behavior problems (unlike fearfulness), particularly in the area of social interactions, another core component of anxiety that is more typically associated with phobic symptoms. Analyses using hierarchical linear modeling (HLM) indicate that the moderating effect of DISC Anxiety continues to favor the inclusion of psychosocial treatment for anxious ADHD children irrespective of the presence or absence of comorbid conduct problems. This effect, which is clinically meaningful, is confined primarily to parent-reported outcomes involving disruptive behavior, internalizing symptoms, and inattention; and is generally stronger for combined than unimodal treatment. Contravening earlier studies, no adverse effect of anxiety on medication response for core ADHD or other outcomes in anxious or nonanxious ADHD children was demonstrated. When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.     

Working From Home: An Initial Pilot Examination of Videoconferencing-Based Cognitive Behavioral Therapy for Anxious Youth Delivered to the Home Setting

Progress in evidence-based treatments for child anxiety has been hampered by limited accessibility of quality care. This study utilized a multiple baseline design to evaluate the pilot feasibility, acceptability, and preliminary efficacy of real-time, Internet-delivered, family-based cognitive-behavioral therapy for child anxiety delivered to the home setting via videoconferencing. Participants included 13 anxious youth (mean age = 9.85) with a primary/co-primary anxiety disorder diagnosis. Eleven participants (84.6%) completed treatment and all study procedures. Consistent with hypotheses, the intervention was feasible and acceptable to families (i.e., high treatment retention, high client satisfaction, strong therapeutic alliance, and low barriers to participation). Moreover, the novel videoconferencing treatment format showed preliminary efficacy: 76.9% of the intention-to-treat (ITT) sample and 90.9% of treatment completers were treatment responders (i.e., Clinical Global Impressions-Improvement Scale = 1 or 2 at posttreatment), and 69.2% of the ITT sample and 81.8% of treatment completers were diagnostic responders (as per the Anxiety Disorders Interview for Children). Gains were largely maintained at 3-month follow-up evaluation. Outcome patterns within and across subjects are discussed, as well as limitations and the need for further controlled evaluations. With continued support, videoconferencing treatment formats may serve to meaningfully broaden the reach of quality care for youth anxiety disorders.     

Cognitive Coping vs Emotional Disclosure in the Treatment of Anxious Children: A Pilot-Study

The present pilot-study was a first attempt to examine the effectiveness of the cognitive component of cognitive behaviour therapy for children with anxiety problems. A total of 24 highly anxious children were assigned to 1 of 2 intervention conditions: a Cognitive Coping intervention, which focussed primarily on the cognitive component of cognitive behaviour therapy, or an Emotional Disclosure intervention in which children were invited to write about their fears and anxious experiences. Children completed self-report questionnaires of anxiety disorders symptoms and worry at 3 points in time: (i) 6 weeks before treatment (i.e. baseline), (ii) at pre-treatment, and (iii) at post-treatment. The results showed, firstly, that levels of anxiety disorder symptoms and worry remained relatively stable over a 6-week waiting period and then decreased substantially after the interventions. This suggests that the children did not suffer from momentary anxiety and worry complaints and that treatments generally were effective in reducing these symptoms. Secondly, although within-group comparisons suggested that treatment effects were somewhat larger in the Cognitive Coping condition than in the Emotional Disclosure condition (effects sizes for anxiety disorders symptoms and worry were, respectively, 1.03 and 0.87 for Cognitive Coping vs 0.54 and 0.39 for Emotional Disclosure), statistical tests could not substantiate this impression, probably due to a lack of power as a result of the small numbers of children in both intervention conditions.     

Early evidence of the Italian validation of the Trait Anxiety Scale of the State-Trait Anxiety Inventory for Children

Anxiety is one of the most widespread disorders in childhood. Researchers claim the need for a tool useful to assess the core constructs common to multiple anxiety disorders, to catch the generalized propensity to be anxious and to assess anxiety stability across the lifespan. The Trait Anxiety Scale of the State-Trait Anxiety Inventory for Children (STAIC-T) seems to fill these gaps. The present study examined STAIC-T validity in a sample of 1324 Italian children aged 8–13 years old. Scalar invariance across gender was established. Internal consistency was good. Results reported higher levels of anxiety in girls, whereas no gender differences were found. The measure demonstrated good convergent validity with the Spence Children Anxiety Scale. Findings support the validity of the STAIC-T as a brief and concise diagnostic tool to assess the anxiety proneness in Italian children.     

Rationale and principles for early intervention with young children at risk for anxiety disorders

Anxiety disorders are one of the most prevalent categories of disorder among adults and children. Children of parents with anxiety disorders are known to be at higher risk for anxiety disorders themselves, with manifestations of this risk often appearing in toddlerhood or early childhood. Yet because affected parents are often unskilled in anxiety management, they often have difficulty in helping their young children learn to manage anxiety. Literature on the course of anxiety disorders through childhood and on effective cognitive-behavioral interventions suggests that preventive interventions even with very young children could potentially be of benefit in mitigating the course of these often debilitating disorders. This paper outlines the rationale for offering early or preventive interventions to preschool-age children at risk and their parents and discusses means of identifying children to target for intervention and the importance of parental involvement. Drawing upon the literature on parental factors in childhood anxiety disorders as well as on effective intervention strategies with preschool-age children, it delineates principles for intervention with parents and effective components of intervention with youngsters in this age range.     

Validating self-report measures of state and trait anxiety against a physiological measure

While anxiety research frequently uses only self-report measures to assess dimensions of state and trait anxiety, the present study sought to corroborate these self-report measures using a physiological measure, namely heart rate. Another aim of the present study was to test the multidimensional interaction model of anxiety in a social evalua-tion situation (i.e., a seminar presentation), using a physiological measure of state anxiety. Graduate psychology students completed a state anxiety questionnaire and were attached to a heart rate recorder prior to a class seminar presentation. One week later, students completed trait and state anxiety questionnaires and were again at-tached to a heart rate recorder prior to seminar observation by others. Heart rate was elevated during seminar presentation relative to seminar observation, reached maxi-mum values during the first 15 minutes of seminar presentation and then decreased over time. State anxiety scores indicate that participants were experiencing consider-ably more anxiety just before presenting the seminar than just before observing a seminar. Heart rate during seminar presentation was significantly correlated with self-report state anxiety and self-report social evaluation trait anxiety, but not with seminar grade. Support was found for the multidimensional interaction model of anxiety using the physiological measure (i.e., heart rate). A modified version of this paper was presented at the 101^st Annual Convention of the American Psychological Association. This research was supported, in part, by Grant No. 410-94-1473 from the Social Sciences and Humanities Research Council of Canada (SSHRC) to the second author. The authors wish to thank the Defence and Civil Institute of Environmental Medicine for providing the Medilog recorders. Reprint requests should be sent to Norman S. Endler at the address above.     

Validating self-report measures of state and trait anxiety against a physiological measure

While anxiety research frequently uses only self-report measures to assess dimensions of state and trait anxiety, the present study sought to corroborate these self-report measures using a physiological measure, namely heart rate. Another aim of the present study was to test the multidimensional interaction model of anxiety in a social evalua-tion situation (i.e., a seminar presentation), using a physiological measure of state anxiety. Graduate psychology students completed a state anxiety questionnaire and were attached to a heart rate recorder prior to a class seminar presentation. One week later, students completed trait and state anxiety questionnaires and were again at-tached to a heart rate recorder prior to seminar observation by others. Heart rate was elevated during seminar presentation relative to seminar observation, reached maxi-mum values during the first 15 minutes of seminar presentation and then decreased over time. State anxiety scores indicate that participants were experiencing consider-ably more anxiety just before presenting the seminar than just before observing a seminar. Heart rate during seminar presentation was significantly correlated with self-report state anxiety and self-report social evaluation trait anxiety, but not with seminar grade. Support was found for the multidimensional interaction model of anxiety using the physiological measure (i.e., heart rate). A modified version of this paper was presented at the 101^st Annual Convention of the American Psychological Association. This research was supported, in part, by Grant No. 410-94-1473 from the Social Sciences and Humanities Research Council of Canada (SSHRC) to the second author. The authors wish to thank the Defence and Civil Institute of Environmental Medicine for providing the Medilog recorders. Reprint requests should be sent to Norman S. Endler at the address above.