Parent-child interactions in children with asthma and anxiety.
Sicouri Gemma,Sharpe Louise,Hudson Jennifer L,Dudeney Joanne,Jaffe Adam,Selvadurai Hiran,Hunt Caroline
Behaviour research and therapy
Anxiety disorders are highly prevalent in children with asthma yet very little is known about the parenting factors that may underlie this relationship. The aim of the current study was to examine observed parenting behaviours - involvement and negativity - associated with asthma and anxiety in children using the tangram task and the Five Minute Speech Sample (FMSS). Eighty-nine parent-child dyads were included across four groups of children (8-13 years old): asthma and anxiety, anxiety only, asthma only and healthy controls. Overall, results from both tasks showed that parenting behaviours of children with and without asthma did not differ significantly. Results from a subcomponent of the FMSS indicated that parents of children with asthma were more overprotective, or self-sacrificing, or non-objective than parents of children without asthma, and this difference was greater in the non-anxious groups. The results suggest that some parenting strategies developed for parents of children with anxiety may be useful for parents of children with asthma and anxiety (e.g. strategies targeting involvement), however, others may not be necessary (e.g. those targeting negativity).
Annual Research Review: An expanded account of information-processing mechanisms in risk for child and adolescent anxiety and depression.
Lau Jennifer Y F,Waters Allison M
Journal of child psychology and psychiatry, and allied disciplines
BACKGROUND:Anxiety and depression occurring during childhood and adolescence are common and costly. While early-emerging anxiety and depression can arise through a complex interplay of 'distal' factors such as genetic and environmental influences, temperamental characteristics and brain circuitry, the more proximal mechanisms that transfer risks on symptoms are poorly delineated. Information-processing biases, which differentiate youth with and without anxiety and/or depression, could act as proximal mechanisms that mediate more distal risks on symptoms. This article reviews the literature on information-processing biases, their associations with anxiety and depression symptoms in youth and with other distal risk factors, to provide direction for further research. METHODS:Based on strategic searches of the literature, we consider how youth with and without anxiety and/or depression vary in how they deploy attention to social-affective stimuli, discriminate between threat and safety cues, retain memories of negative events and appraise ambiguous information. We discuss how these information-processing biases are similarly or differentially expressed on anxiety and depression and whether these biases are linked to genetic and environmental factors, temperamental characteristics and patterns of brain circuitry functioning implicated in anxiety and depression. FINDINGS:Biases in attention and appraisal characterise both youth anxiety and depression but with some differences in how these are expressed for each symptom type. Difficulties in threat-safety cue discrimination characterise anxiety and are understudied in depression, while biases in the retrieval of negative and overgeneral memories have been observed in depression but are understudied in anxiety. Information-processing biases have been studied in relation to some distal factors but not systematically, so relationships remain inconclusive. CONCLUSIONS:Biases in attention, threat-safety cue discrimination, memory and appraisal may characterise anxiety and/or depression risk. We discuss future research directions that can more systematically test whether these biases act as proximal mechanisms that mediate other distal risk factors.
Associations of child and adolescent anxiety with later alcohol use and disorders: a systematic review and meta-analysis of prospective cohort studies.
Dyer Maddy L,Easey Kayleigh E,Heron Jon,Hickman Matthew,Munafò Marcus R
Addiction (Abingdon, England)
BACKGROUND AND AIMS:Despite a wealth of literature, the relationship between anxiety and alcohol use remains unclear. We examined whether (a) child and adolescent anxiety is positively or negatively associated with later alcohol use and disorders and (b) study characteristics explain inconsistencies in findings. DESIGN AND SETTING:We conducted a systematic review of 51 prospective cohort studies from 11 countries. Three studies contributed to a meta-analysis. We searched PubMed, Scopus, Web of Science and PsycINFO databases, and studies were included if they met the following criteria: English language publication, human participants, anxiety exposure (predictor variable) in childhood or adolescence and alcohol outcome at least 6 months later. PARTICIPANTS:Study sample sizes ranged from 110 to 11 157 participants. Anxiety exposure ages ranged from 3 to 24 years, and alcohol outcome ages ranged from 11 to 42 years. MEASUREMENTS:Ninety-seven associations across 51 studies were categorized by anxiety exposure (generalized anxiety disorder, internalizing disorders, miscellaneous anxiety, obsessive compulsive disorder, panic disorder, separation anxiety disorder, social anxiety disorder and specific phobias) and alcohol use outcome (drinking frequency/quantity, binge drinking and alcohol use disorders). FINDINGS:The narrative synthesis revealed some evidence for a positive association between anxiety and later alcohol use disorders. Associations of anxiety with later drinking frequency/quantity and binge drinking were inconsistent. Type and developmental period of anxiety, follow-up duration, sample size and confounders considered did not appear to explain the discrepant findings. The meta-analysis also showed no clear evidence of a relationship between generalized anxiety disorder and later alcohol use disorder (odds ratio = 0.94, 95% confidence interval = 0.47-1.87). CONCLUSIONS:Evidence to date is suggestive, but far from conclusive of a positive association between anxiety during childhood and adolescence and subsequent alcohol use disorder.
Treating child and adolescent anxiety effectively: Overview of systematic reviews.
Bennett Kathryn,Manassis Katharina,Duda Stephanie,Bagnell Alexa,Bernstein Gail A,Garland E Jane,Miller Lynn D,Newton Amanda,Thabane Lehana,Wilansky Pamela
Clinical psychology review
We conducted an overview of systematic reviews about child and adolescent anxiety treatment options (psychosocial; medication; combination; web/computer-based treatment) to support evidence informed decision-making. Three questions were addressed: (i) Is the treatment more effective than passive controls? (ii) Is there evidence that the treatment is superior to or non-inferior to (i.e., as good as) active controls? (iii) What is the quality of evidence for the treatment? Pre-specified inclusion criteria identified high quality systematic reviews (2000-2015) reporting treatment effects on anxiety diagnosis and symptom severity. Evidence quality (EQ) was rated using Oxford evidence levels [EQ1 (highest); EQ5 (lowest)]. Twenty-two of 39 eligible reviews were high quality (AMSTAR score≥3/5). CBT (individual or group, with or without parents) was more effective than passive controls (EQ1). CBT effects compared to active controls were mixed (EQ1). SSRI/SNRI were more effective than placebo (EQ1) but comparative effectiveness remains uncertain. EQ for combination therapy could not be determined. RCTs of web/computer-based interventions showed mixed results (EQ1). CBM/ABM was not more efficacious than active controls (EQ1). No other interventions could be rated. High quality RCTs support treatment with CBT and medication. Findings for combination and web/computer-based treatment are encouraging but further RCTs are required. Head-to-head comparisons of active treatment options are needed.
Anxiety Measures Predict Health-Related Quality of Life in Children and Adolescents with Cyclic Vomiting Syndrome.
Tarbell Sally E,Li B U K
The Journal of pediatrics
OBJECTIVE:To evaluate the relationship between anxiety and health-related quality of life (HRQoL) in children and adolescents with cyclic vomiting syndrome (CVS). STUDY DESIGN:Forty children aged 8-18 years diagnosed with CVS and 40 parents completed the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the child and parent forms of the Pediatric Quality of Life Generic Core Scale, a measure of HRQoL. RESULTS:Eleven of the 40 children (27%) by self-report and 6 of 40 (15%) by parent-proxy report met the clinical cutoff for an anxiety disorder on the SCARED. Parent and child SCARED ratings were moderately correlated (intraclass correlation coefficient 0.68; P < .001). Child-rated HRQoL (mean ± SD, 74.3 ± 15.2) and parent-rated HRQoL (mean, 72.1 ± 14.6) were lower than healthy norms (P < .001). Disease severity (mean duration of CVS episodes, 3 ± 2.4 days), annual frequency of CVS episodes (mean, 8.2 ± 15.3), chronicity of CVS (mean, 5.8 ± 3.4 years), and delay in diagnosis (mean, 2.4 ± 1.9 years) were not associated with child-reported HRQoL; however, child SCARED scores accounted for approximately 50% of the variance in child-reported HRQoL (adjusted R(2) = 0.49; df = 1, 38; P < .001). CONCLUSION:Children and adolescents with CVS appear to be at increased risk for anxiety. Anxiety symptoms are a stronger predictor of HRQoL than disease characteristics in children and adolescents with CVS. Assessment and treatment of anxiety in children and adolescents with CVS may have a positive impact on HRQoL.
Association of physical activity level with depression, anxiety, and quality of life in children with type 1 diabetes mellitus.
Mutlu Ebru Kaya,Mutlu Caner,Taskiran Hanifegul,Ozgen Ilker Tolga
Journal of pediatric endocrinology & metabolism : JPEM
BACKGROUND:Children with type 1 diabetes mellitus (T1DM) have low physical activity levels and are at high risk for psychosocial morbidities, including depression, heightened anxiety and low health-related quality of life (HRQoL). OBJECTIVE:The aim of this study was to assess the associations of physical activity level with depression, anxiety, and HRQoL in children with T1DM. SUBJECTS AND METHODS:A cross-sectional study design, including children with T1DM aged between 8 and 12 years and healthy controls, was used. Physical activity (PA) level was assessed with the Physical Activity Questionnaire for Older Children (PAQ-C). Anxiety was screened by The Screen for Anxiety Related Emotional Disorders (SCARED) questionnaire. Depressive symptoms were evaluated using the Children's Depression Inventory (CDI). Quality of life was assessed with the The Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0). RESULTS:Forty-seven T1DM and 55 healthy children were included with mean ages of 9.87±1.63 and 9.56±1.60 years, respectively. The T1DM group had significantly higher depression and anxiety score (p<0.05) and lower HRQoL-child self-report score (p<0.05, for all) compared with the control group. Significant associations were found between PAQ-C and PedsQL 4.0 (p<0.05), between SCARED and PedsQL 4.0 (p<0.05), and between HbA1c and PedsQL 4.0 (p<0.05) in children with T1DM. CONCLUSIONS:The result of our study suggested that only HRQoL was related to physical activity, anxiety and HbA1c in children with T1DM.
The Relationship Between Plasma Cytokine Levels and Response to Selective Serotonin Reuptake Inhibitor Treatment in Children and Adolescents with Depression and/or Anxiety Disorders.
Amitai Maya,Taler Michal,Carmel Miri,Michaelovsky Elena,Eilat Tamar,Yablonski Maya,Orpaz Naama,Chen Alon,Apter Alan,Weizman Abraham,Fennig Silvana
Journal of child and adolescent psychopharmacology
OBJECTIVE:In adults there is growing evidence that antidepressant (AD) treatment results in a decline in inflammatory cytokines. This is the first report, to our knowledge, of the relationship between response to selective serotonin reuptake inhibitor (SSRI) treatment for anxiety and/or depression and cytokine levels in children and adolescents. METHODS:Forty-one patients who met Diagnostic and Statistical Manual for Mental Disorders, 4th ed. (DSM-IV) criteria for major depressive disorder (MDD) or anxiety disorders participated in study. Their ages ranged from 9 to 18 (14.12 ± 2.30) years. The patients were treated with fluoxetine for 8 weeks. Plasma concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β were measured by enzyme linked immunosorbent assays (ELISA) before and after fluoxetine treatment. Clinical response was measured with several scales, including the Children's Depression Rating Scale-Revised (CDRS-R), the Beck Depression Inventory (BDI), and the Screen for Child Anxiety Related Emotional Disorders (SCARED) Results: The overall response rate was 56%. Antidepressant treatment significantly reduced TNF-α levels (p = 0.037), with no significant changes in the levels of IL-6 and IL-1β. All three proinflammatory cytokines were significantly (p < 0.05) higher in SSRI-refractory than in SSRI-responsive patients. CONCLUSIONS:Higher levels of TNF-α, IL-6, and IL-1β might predict nonresponse to fluoxetine treatment in children.
Chronic Physical Health Conditions and Emotional Problems From Early Adolescence Through Midadolescence.
Jones LaRita C,Mrug Sylvie,Elliott Marc N,Toomey Sara L,Tortolero Susan,Schuster Mark A
OBJECTIVE:Chronic physical health conditions are highly prevalent in youth, frequently persisting into adulthood and contributing to the current and future health care burden in the United States. Our study evaluated associations of chronic physical health conditions with depressive and physiological anxiety symptoms in a community sample of youth and examined how those associations changed from early to midadolescence. METHODS:In this longitudinal study of 5147 youth, students and their caregivers were interviewed when youth were in grades 5 (mean age = 11), 7 (mean age = 13), and 10 (mean age = 16). Caregivers reported family sociodemographics, youth race/ethnicity, and youth chronic physical health history at baseline. Youth reported their depressive symptoms at each time point and their physiological anxiety symptoms at grades 7 and 10. RESULTS:At age 11, 28.5% had experienced a chronic physical health condition. Having any chronic physical health condition was related to elevated depressive symptoms at age 11 (2.05 ± 0.05 vs 1.89 ± 0.03; mean ± standard error; P < .01) and anxiety symptoms at age 16 (2.72 ± 0.06 vs 2.55 ± 0.04; P < .05). Experiencing multiple conditions was also related to experiencing more depressive symptoms (b = 0.13; P < .01) and physiological anxiety symptoms (b = 0.13; P < .05). After adjusting for previous mental health symptoms, having any condition still predicted anxiety at age 16. CONCLUSIONS:Children with chronic physical health conditions have an increased risk of depressive symptoms and physiological anxiety symptoms, especially in early and midadolescence. Repeated screening for these symptoms may help identify children in need of interventions.
Prevalence of DSM-5 anxiety disorders, comorbidity, and persistence of symptoms in Spanish early adolescents.
Canals Josefa,Voltas Núria,Hernández-Martínez Carmen,Cosi Sandra,Arija Victoria
European child & adolescent psychiatry
Anxiety Disorders (AD) are the most prevalent mental disorders in children and adolescents and a relevant public health problem. The study aimed to determine the prevalence of ADs, the comorbidity, the sociodemographic correlates, and the functional impairment in Spanish school children. The initial sample included 1514 subjects (720 boys; mean age = 10.2), who filled out the Screen for Children's Anxiety-Related Emotional Disorders (SCARED). In a second phase, 562 subjects at risk and not-at-risk of anxiety were assessed with the Mini-International Neuropsychiatric Interview for Children and Adolescents to obtain DSM-5 diagnoses. Two years later (third phase; mean age 13.5), the SCARED was re-administered. The weighted prevalence of any AD was 11.8%. The most prevalent subtypes were specific phobia (16.2%) and generalized anxiety disorder (GAD) (6.9%). Girls showed higher rates of social anxiety (5.5%) than boys. Apart from being female, low socioeconomic status was also a risk factor for AD. The heterotypic comorbidity of any AD was 40.7%, and the homotypic comorbidity was 35.6%. After controlling for age and other ADs, we found that subjects with GAD had the highest risk of having other depressive disorders and ADs. Only 33.3% of the subjects with any AD had sought professional help. 52.9% of the subjects diagnosed with any of the ADs still had anxiety symptoms after a 2-year follow-up. These findings highlight that in Spain, ADs in early adolescence are an important public health problem and that detection and access to treatment need to be improved.
Children's Perioperative Multidimensional Anxiety Scale (CPMAS): Development and validation.
Chow Cheryl H T,Van Lieshout Ryan J,Buckley Norman,Schmidt Louis A
Up to 5 million children are affected by perioperative anxiety in North America each year. High perioperative anxiety is predictive of numerous adverse emotional and behavioral outcomes in youth. We developed the Children's Perioperative Multidimensional Anxiety Scale (CPMAS) to address the need for a simple, age-appropriate self-report measure of pediatric perioperative anxiety in busy hospital settings. The CPMAS is a visual analog scale composed of 5 items, each of which is scored from 0-100. The objective of this study was to assess the psychometric properties of the CPMAS in children undergoing surgery. Eighty children aged 7 to 13 years who were undergoing elective surgery at a university-affiliated children's hospital were recruited. Children self-completed the CPMAS and the Screen for Childhood Anxiety Related Disorders (SCARED-C) at 3 time points: at preoperative assessment (T1), on the day of the operation (T2), and 1 month postoperatively (T3). Internal consistency, test-retest reliability, and the convergent validity of the CPMAS were assessed across all 3 visits. The CPMAS demonstrated good internal consistency (Cronbach's alpha ≥ .80) and stability (ICC = 0.71) across all 3 visits. CPMAS scores were moderately correlated with total SCARED-C scores (r values = .35 to .54, p values < .05 to .01) and SCARED-C state-related anxiety scores (r values = .29 to .71, p values < .05 to .01) at all 3 time points, suggesting the CPMAS and SCARED-C measures tap similar but not identical phenomena. These results suggest that the CPMAS has the potential to be a useful tool for evaluating perioperative anxiety in children undergoing surgery. (PsycINFO Database Record
Extended Release Guanfacine in Pediatric Anxiety Disorders: A Pilot, Randomized, Placebo-Controlled Trial.
Strawn Jeffrey R,Compton Scott N,Robertson Brigitte,Albano Anne Marie,Hamdani Mohamed,Rynn Moira A
Journal of child and adolescent psychopharmacology
OBJECTIVE:This is a feasibility study evaluating the safety, tolerability, and potential anxiolytic efficacy of the α agonist guanfacine extended-release (GXR) in children and adolescents with generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia/social anxiety disorder. METHODS:Youth aged 6-17 years with a primary diagnosis of GAD, SAD, and/or social anxiety disorder were treated with flexibly dosed GXR (1-6 mg daily, n = 62) or placebo (n = 21) for 12 weeks. The primary aim of this study was to determine the safety and tolerability of GXR in youth with anxiety disorders, which involved the analysis of treatment-emergent adverse events (TEAEs), the emergence of suicidal ideation and behaviors, vital signs, and electrocardiographic/laboratory parameters. Exploratory efficacy measures included dimensional anxiety scales (Pediatric Anxiety Rating Scale [PARS] and Screen for Child Anxiety Related Emotional Disorders [SCARED]), as well as the Clinical Global Impression-Improvement (CGI-I) scale. As this was an exploratory study, no inferential statistical analyses were performed. RESULTS:GXR was safe and well tolerated. Treatment-related mean ± standard deviation changes in heart rate (GXR: 1.8 ± 12 beats per minute [bpm] decrease; placebo: 0.5 ± 11 bpm decrease), systolic blood pressure (GXR: 2.3 ± 11 mm Hg decrease; placebo: 1.7 ± 11 mm Hg decrease), or diastolic blood pressure (GXR: 1.3 ± 9 mm Hg decrease; placebo: 0.9 ± 7 mm Hg increase) were similar between treatment groups. TEAEs, including headache, somnolence/fatigue, abdominal pain, and dizziness, were consistent with the known safety profile of GXR. No differences were observed between treatment groups for PARS and SCARED scores, although at endpoint, a higher proportion of subjects receiving GXR versus placebo demonstrated CGI-I scores ≤2 (54.2% vs. 31.6%), as rated by the clinician investigator. CONCLUSIONS:GXR was well tolerated in pediatric subjects with GAD, SAD, and/or social anxiety disorder. ClinicalTrials.gov Identifier: NCT01470469.
Agreement between children and parents when reporting anxiety and depressive symptoms in pediatric epilepsy.
Stevanovic Dejan,Jancic Jasna,Topalovic Mirko,Tadic Ivana
Epilepsy & behavior : E&B
The levels of agreement between self- and parent/proxy-reports of anxiety and depressive symptoms in pediatric epilepsy were evaluated. Data were drawn from 56 pairs of children with epilepsy and at least one parent. Anxiety symptoms were assessed using the Screen for Child Anxiety Related Emotional Disorders (SCARED), while depressive symptoms were assessed using the Mood and Feeling Questionnaire (MFQ). Moderate to substantial levels of agreement between raters when reporting various anxiety symptoms, such as panic/somatic disorder, generalized anxiety disorder, separation anxiety disorder, social phobia, and school phobia symptoms, were observed. Levels of agreement between raters were substantial when reporting depressive symptoms. However, levels of agreement differed if raw or criterion-referenced questionnaires' scores were used. In case of using raw questionnaire scores, substantial agreements appeared when reporting overall anxiety and depressive symptoms. On the other hand, moderate agreements appeared when reporting particular anxiety symptoms with raw questionnaire scores or when using criterion-referenced scores that indicate the presence of certain symptoms in a clinical range. Therefore, it is advisable to include both raters when assessing anxiety and depressive symptoms in pediatric epilepsy.
A clinical study of anxiety disorders in children and adolescents from North Indian children and adolescents clinic.
Mohapatra Satyakam,Agarwal Vivek,Sitholey Prabhat,Arya Amit
Asian journal of psychiatry
BACKGROUND AND OBJECTIVES:Anxiety disorders are the most common group of psychiatric disorders in children and adolescents. But few studies on specific anxiety disorders in children and adolescents are available in India. Therefore, this study was planned to identify anxiety disorders in children and adolescents in an Indian psychiatry outpatient setting and elicit its phenomenology and co-morbidities. METHODS:1465 persons were screened using screen for child anxiety related emotional disorders (SCARED) scale. The screen positive patients were assessed and diagnosis of anxiety disorders was established according to DSM-IV-TR. Detailed assessment of the phenomenology of anxiety disorders was done by K-SADS-PL. RESULTS:42 (2.86%) patients had different anxiety disorders. Out of which 16 (38.1%) patients had obsessive compulsive disorder, 10 (23.81%) patients with specific phobias, 6 (14.29%) patients with generalized anxiety disorder, 4 (9.52%) patients with social anxiety disorder and 3 (7.14%) patients each with separation anxiety disorder and panic disorder. Co-morbidities were found in 54% of patients with anxiety disorders. Dissociative disorder, specific phobias and social anxiety disorder were the common co-morbidities. INTERPRETATION AND CONCLUSION:Anxiety disorders are less commonly found in clinic settings (2.86%). No case of posttraumatic stress disorder or acute stress reaction was found in this study.
Depression and anxiety in child and adolescents with follow-up celiac disease and in their families.
Esenyel Selcen,Unal Fatih,Vural Pınar
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology
BACKGROUND/AIMS:Earlier research has indicated a positive association between Celiac disease and some mental disorders in both adults and children. The aim of this study was to explore the diet compliance and depression and anxiety levels of pediatric celiac children and their families after a gluten-free diet. MATERIALS AND METHODS:A total of 30 celiac pediatric patients (17 children [57%] and 13 adolescents [43%]) were enrolled in the study, and 20 healthy controls (11 children [55%] and 9 adolescents [45%]) were studied as controls. Depression was assessed with the Children's Depression Inventory (CDI) form, and anxiety was assessed with the Screen for Child Anxiety Related Disorders (SCARED) form. Diet compliance was measured with a diet compliance form, and the families were asked to complete the Beck Depression Measurement (BDI) form for depression and the State-Trait Anxiety Inventory I-II (STAI-I and STAI-II) forms for anxiety. RESULTS:There was no significant difference in depression and anxiety between pediatric celiac patients consuming a gluten-free diet and the healthy control group. We observed no difference in depression and anxiety in the Celiac CD group patients. Diet compliance was 73.3% in the study group. CONCLUSION:The depression and anxiety levels of pediatric celiac patients and their parents did not differ from those in the healthy group.
Anxiety symptoms and disease severity in children and adolescents with Crohn disease.
Reigada Laura C,Hoogendoorn Claire J,Walsh Lindsay C,Lai Joanne,Szigethy Eva,Cohen Barry H,Bao Ruijun,Isola Kimberly,Benkov Keith J
Journal of pediatric gastroenterology and nutrition
OBJECTIVES:Children and adolescents diagnosed as having Crohn disease (CD), a type of inflammatory bowel disease (IBD), have increased vulnerability for anxiety symptoms that may be related to disease-related processes. The aims of this article are 3-fold: to report the proportion of pediatric patients with CD whose self-reported anxiety symptoms are indicative of distress, to describe the constellation of anxiety symptoms, and to examine the relation between anxiety and disease symptoms. METHODS:Retrospective medical chart review was performed for 93 youths with CD (ages 9-18 years) who had completed the Screen for Child Anxiety Related Disorders during their gastroenterology visit. Medical records were reviewed for demographic and disease characteristics. the Harvey-Bradshaw Index (HBI) was used as a measure of CD activity. RESULTS:Thirty percent of the youths reported experiencing elevated anxiety symptoms (Screen for Child Anxiety Related Disorder score >20), and 50% had scored above the cutoff in 1 or more anxiety domains, with school anxiety, general anxiety, and separation anxiety symptoms reported most frequently. Youth rated with moderate/severe disease activity on the HBI (n = 4) self-reported more anxiety symptoms compared with youth with inactive disease (n = 78, P = 0.03). Greater school anxiety was significantly associated with decreased well-being (P = 0.003), more abdominal pain (P < 0.001), and the number of loose stools (P = 0.01). Having extraintestinal symptoms was significantly associated with higher somatic/panic anxiety (P = 0.01). CONCLUSIONS:Implementing a brief anxiety screen in tertiary pediatric settings may be one approach to identify young patients with CD in distress. Health care providers should consider periodic assessment of school anxiety among youth with CD.
Cross-ethnic measurement invariance of the SCARED and CES-D in a youth sample.
Skriner Laura C,Chu Brian C
This study evaluated the cross-ethnic measurement invariance of 2 common screening measures of anxiety and depressive symptoms in youth. The measurement invariance of the Screen for Childhood Anxiety and Related Emotional Disorders (SCARED) and the Center for Epidemiologic Studies Depression Scale (CES-D) was tested across 881 African American (Black; n = 396), Hispanic (n = 185), non-Hispanic White (White; n = 166), and Asian/Indian (n = 134) youth in the 7th grade. The measures were administered as part of a grade-wide screening to identify youth with elevated anxiety and depressive symptoms. The 5-factor model of the SCARED and the 4-factor model of the CES-D best represented the data for all ethnic groups. Results provided support for strong invariance of the SCARED across all 4 ethnic groups. Results provided support for strong invariance of the CES-D across Black, White, and Asian/Indian youth, and partial strong invariance for Hispanic youth. Overall, results suggest that factor means and total scores can be compared across groups. Factor mean differences across groups were identified for both measures. In particular, Hispanic youth reported greater levels of anxiety and depression in certain domains than White, Black, and Asian youth. Our findings support the use of the SCARED and CES-D as tools for measuring anxiety and depressive symptoms in ethnically diverse youth in the United States. Results are discussed with respect to the importance of establishing measurement invariance for screening measures of anxiety and depressive symptoms prior to comparing symptom levels across ethnic groups.
Identifying Differences in Risk Factors for Depression and Anxiety in Pediatric Chronic Disease: A Matched Cross-Sectional Study of Youth with Lupus/Mixed Connective Tissue Disease and Their Peers with Diabetes.
Knight Andrea,Weiss Pamela,Morales Knashawn,Gerdes Marsha,Rearson Melissa,Vickery Michelle,Keren Ron
The Journal of pediatrics
OBJECTIVE:To investigate differences in risk factors for depression and anxiety, such as central nervous system involvement in systemic lupus erythematosus (SLE)/mixed connective tissue disease (MCTD), by comparing youth with SLE/MCTD to peers with type 1 diabetes mellitus (T1D). STUDY DESIGN:We conducted a cross-sectional study of 50 outpatient pairs, ages 8 years and above, matching subjects with SLE/MCTD and T1D by sex and age group. We screened for depression, suicidal ideation, and anxiety using the Patient Health Questionnaire-9 and the Screen for Childhood Anxiety Related Emotional Disorders, respectively. We collected parent-reported mental health treatment data. We compared prevalence and treatment rates between subjects with SLE/MCTD and T1D, and identified disease-specific risk factors using logistic regression. RESULTS:Depression symptoms were present in 23%, suicidal ideation in 15%, and anxiety in 27% of participants. Compared with subjects with T1D, subjects with SLE/MCTD had lower adjusted rates of depression and suicidal ideation, yet poorer rates of mental health treatment (24% vs 53%). Non-White race/ethnicity and longer disease duration were independent risk factors for depression and suicidal ideation. Depression was associated with poor disease control in both groups, and anxiety with insulin pump use in subjects with T1D. CONCLUSION:Depression and anxiety are high and undertreated in youth with SLE/MCTD and T1D. Focusing on risk factors such as race/ethnicity and disease duration may improve their mental health care. Further study of central nervous system and other disease-related factors may identify targets for intervention.
The latent profile analysis of Chinese adolescents' anxiety: Examination and validation.
Yu Meng,Chasson Gregory S,Wang Mengcheng,Zhu Yawen,Xu Qian,Wang Jianping
Journal of anxiety disorders
The main purpose of current study was to investigate the characteristics of anxiety in Chinese adolescents using Latent Profile Analysis (LPA) with the Screen for Child Anxiety Related Emotional Disorders. LPA was conducted with a sample of 2158 participants aged 12-20 years from 3 urban schools in Beijing, China. Results suggested a best-fitting model with three profiles: Low Group with Diffuse Types of Anxiety, Moderate Group with Predominant Generalized and Social Anxiety and High Group with Predominant Somatization Anxiety. Additional analyses using Regression Mixture Modeling suggested that older adolescents and girls were significantly more likely to be classified into the High Group with Predominant Somatization Anxiety. Finally, in support of the construct validity of the anxiety profiles, differential negative cognitions, especially the subscales measuring cognitions about social threat and physical threat, predicted the anxiety profiles. The current study supports an intuitive model of adolescent anxiety in a large, non-Western population with clinical implications for anxious adolescents in China.
The natural course of anxiety symptoms in early adolescence: factors related to persistence.
Voltas Núria,Hernández-Martínez Carmen,Arija Victoria,Canals Josefa
Anxiety, stress, and coping
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.
Parental Involvement in CBT for Anxiety-Disordered Youth Revisited: Family CBT Outperforms Child CBT in the Long Term for Children With Comorbid ADHD Symptoms.
Maric Marija,van Steensel Francisca J A,Bögels Susan M
Journal of attention disorders
OBJECTIVE:The objective of this study was to examine the efficacy of child cognitive-behavioral therapy (CCBT) versus family CBT (FCBT) in anxiety-disordered youth with high and low comorbid ADHD symptoms. METHOD:Youth with anxiety disorders ( n = 123, aged 8-18) were classified in four groups according to (a) the type of CBT received (child vs. family) and (b) their comorbid ADHD symptoms, measured with the Child Behavior Checklist (CBCL) Attention Problems syndrome scale level (normal vs. [sub]clinical). Severity of anxiety disorders was assessed with Anxiety Disorders Interview Schedule-Child and Parent (ADIS-C/P) version and anxiety symptoms via a 71-item anxiety symptom questionnaire, the Screen for Child Anxiety and Related Emotional Disorders (SCARED-71), before and after CBT, and at 3 months and 1-year follow-ups. RESULTS:Based on the severity of anxiety disorders, children with high ADHD symptoms profit more from FCBT than CCBT in the long term. For children low on ADHD symptoms, and for anxiety symptoms and attention problems, no differences between CCBT and FCBT occurred. CONCLUSION:Family involvement seems a valuable addition to CBT for children with comorbid anxiety and ADHD symptoms.
Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in the general Italian adolescent population: a validation and a comparison between Italy and The Netherlands.
Crocetti Elisabetta,Hale William W,Fermani Alessandra,Raaijmakers Quinten,Meeus Wim
Journal of anxiety disorders
In this study examination is given to the psychometric properties of the Italian version of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a large community sample of adolescents. Additionally, a comparison was made between the anxiety scores of this Italian adolescent cohort (N=1975) and a comparative Dutch adolescent cohort (N=1115). Findings revealed that a five-factor structure of the SCARED applied not only to the Italian adolescents from the general community, but also to boys and girls, and to early and middle adolescents. Moreover, sex and age differences on anxiety scores within the Italian sample were found to be consistent with previous studies of adolescent anxiety disorders. Finally, Italian adolescents reported higher anxiety scores than their Dutch peers. Findings of this study highlight that the SCARED is a valid screening instrument to rate anxiety symptoms of Italian adolescents.
Cognitive, emotional, and behavioral profile in children and adolescents with chronic pain associated with rheumatic diseases: A case-control study.
Pascali Maria,Matera Emilia,Craig Francesco,Torre Francesco La,Giordano Paola,Margari Francesco,Zagaria Giuseppina,Margari Mariella,Margari Lucia
Clinical child psychology and psychiatry
BACKGROUND:The prevalence of chronic pain is about 30% in children and adolescents which suffer from severe emotional distress. The aim of this observational study is to investigate cognitive, emotional and behavioral consequences of benign chronic pain in children and adolescents suffering of reumathologic diseases. MATERIALS AND METHODS:A total of 49 participants, chronic pain participants (CPPs) and controls (CGPs), affected by rheumatic diseases, were enrolled. Assessment included collection of sociodemographic data, pain characteristics, and administration of Visual Analog Scale (VAS), Depression Inventory for Children and Adolescents (CDI), Conners' Parent Rating Scales-Revised (CPRS-R), Child Behavior Checklist (CBCL), and Screen for Child Anxiety-Related Disorders (SCARED). For the statistical analysis, Student's -test for independent samples and Pearson's correlation were used. The significance value was set at less than .05. RESULTS:A significant difference of mean scores of CBCL items and of CPRS items between the two groups was found. In CPPs, a significant correlation between VAS and mean scores of several CBCL items and between VAS and mean scores of several CPRS items was found. CONCLUSION:Chronic pain is a real syndrome in which an interdisciplinary treatment should be applied, considering the psychopathological risk, especially in developmental age.
Anxiety in adolescent epilepsy. A clinimetric analysis.
Carrozzino Danilo,Marchetti Daniela,Laino Daniela,Minna Maria,Verrocchio Maria Cristina,Fulcheri Mario,Verrotti Alberto,Bech Per
Nordic journal of psychiatry
Background Anxiety and depression have been considered to be neglected disorders in epilepsy. Because panic disorder is one of the most important anxiety disorders, it has been problematic to use very comprehensive anxiety questionnaires in epilepsy patients, as panic attacks and epileptic seizures, although two distinct clinical entities from a diagnostic point of view, show a significant overlap of symptoms. Aims We have focused on single items for anxiety and depression as screening candidates in adolescent epilepsy. Methods The individual panic attack item in the Screen for Children Anxiety Related Emotional Disorders Scale (SCARED) and the single depression item in the Kellner Symptom Questionnaire were tested. Our samples consisted of adolescent patients with epilepsy and a matched control group with healthy participants, as well as two numerical groups acting as controls. Results The single panic attack item identified panic anxiety in 24.1% in the group of patients with epilepsy and 0.0% in the matched control group (p = 0.01). The single depression item identified 52.2% with depression in the epilepsy group and 6.2% in the matched control group (p = 0.001). Conclusion As screening instruments, single items of panic attack and depression are sufficient to screen for these affective states in adolescent epilepsy. The clinical implications are that it is important to be quite specific when screening for depression and panic attacks in adolescent patients with epilepsy.
Association of Irritability and Anxiety With the Neural Mechanisms of Implicit Face Emotion Processing in Youths With Psychopathology.
Stoddard Joel,Tseng Wan-Ling,Kim Pilyoung,Chen Gang,Yi Jennifer,Donahue Laura,Brotman Melissa A,Towbin Kenneth E,Pine Daniel S,Leibenluft Ellen
Importance:Psychiatric comorbidity complicates clinical care and confounds efforts to elucidate the pathophysiology of commonly occurring symptoms in youths. To our knowledge, few studies have simultaneously assessed the effect of 2 continuously distributed traits on brain-behavior relationships in children with psychopathology. Objective:To determine shared and unique effects of 2 major dimensions of child psychopathology, irritability and anxiety, on neural responses to facial emotions during functional magnetic resonance imaging. Design, Setting, and Participants:Cross-sectional functional magnetic resonance imaging study in a large, well-characterized clinical sample at a research clinic at the National Institute of Mental Health. The referred sample included youths ages 8 to 17 years, 93 youths with anxiety, disruptive mood dysregulation, and/or attention-deficit/hyperactivity disorders and 22 healthy youths. Main Outcomes and Measures:The child's irritability and anxiety were rated by both parent and child on the Affective Reactivity Index and Screen for Child Anxiety Related Disorders, respectively. Using functional magnetic resonance imaging, neural response was measured across the brain during gender labeling of varying intensities of angry, happy, or fearful face emotions. In mixed-effects analyses, the shared and unique effects of irritability and anxiety were tested on amygdala functional connectivity and activation to face emotions. Results:The mean (SD) age of participants was 13.2 (2.6) years; of the 115 included, 64 were male. Irritability and/or anxiety influenced amygdala connectivity to the prefrontal and temporal cortex. Specifically, irritability and anxiety jointly influenced left amygdala to left medial prefrontal cortex connectivity during face emotion viewing (F4,888 = 9.20; P < .001 for mixed model term). During viewing of intensely angry faces, decreased connectivity was associated with high levels of both anxiety and irritability, whereas increased connectivity was associated with high levels of anxiety but low levels of irritability (Wald χ21 = 21.3; P < .001 for contrast). Irritability was associated with differences in neural response to face emotions in several areas (F2, 888 ≥ 13.45; all P < .001). This primarily occurred in the ventral visual areas, with a positive association to angry and happy faces relative to fearful faces. Conclusions and Relevance:These data extend prior work conducted in youths with irritability or anxiety alone and suggest that research may miss important findings if the pathophysiology of irritability and anxiety are studied in isolation. Decreased amygdala-medial prefrontal cortex connectivity may mediate emotion dysregulation when very anxious and irritable youth process threat-related faces. Activation in the ventral visual circuitry suggests a mechanism through which signals of social approach (ie, happy and angry expressions) may capture attention in irritable youth.
Comparing family accommodation in pediatric obsessive-compulsive disorder, anxiety disorders, and nonanxious children.
Lebowitz Eli R,Scharfstein Lindsay A,Jones Johnna
Depression and anxiety
BACKGROUND:Family accommodation describes ways in which parents modify their behavior to help a child avoid or alleviate distress caused by emotional disorders. Accommodation is associated with increased symptom severity, lower functioning, and poorer treatment outcomes. Accommodation is prevalent in childhood obsessive-compulsive disorder (OCD) and anxiety disorders (ADs) but no studies have compared accommodation in these groups or compared them to healthy controls to ascertain if accommodation is prevalent in the general population. This study addresses these gaps by comparing patterns of accommodation, factors that maintain accommodation, and its relation to symptom severity in OCD and AD, relative to healthy controls. METHOD:We directly compared reports of accommodation to childhood OCD (N = 26) and AD (N = 31), and a comparison group of nonanxious (NA) children (N = 30). Mothers completed measures of accommodation (Family Accommodation Scale (FAS)/Family Accommodation Scale-Anxiety (FASA)), anxiety (Screen for Childhood Anxiety Related Emotional Disorders-Parent Report (SCARED-PR)), and OCD (Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS)). RESULTS:Family accommodation is prevalent among mothers of children with OCD and AD. Few differences were found between the two clinical groups who reported more accommodation (F[2,84] = 23.411, P < .001, partial η(2) = .358), greater distress (F[2,84] = 24.050, P < .001, partial η(2) = .364), and more consequences of not accommodating (F[2,84] = 18.967, P < .001, partial η(2) = .311), than the NA group. Accommodation was associated with severity of anxiety in AD (r = .426, P = .017) and OCD (r = .465, P = .017), but not in the NA group. CONCLUSIONS:Findings highlight family accommodation as a phenomenon that applies broadly and in a similar manner to children with AD and OCD. Evaluating accommodation provides useful information for clinical care and is an important part of the assessment of children with AD and OCD.
Health-related quality of life and emotional problems in juvenile idiopathic arthritis.
Stevanovic Dejan,Susic Gordana
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
PURPOSE:Children with juvenile idiopathic arthritis (JIA) are at an increased risk of developing emotional problems. This study evaluated the associations between levels of depressive and anxiety symptoms and health-related quality of life (HRQOL) in these children. METHODS:Sixty-seven children with JIA, together with one parent, participated. Anxiety symptoms were identified using the Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED), while depressive symptoms were identified using the Mood and Feeling Questionnaire (MFQ). The Pediatric Quality of Life Inventory (PedsQL) was used for HRQOL assessments. Using hierarchical multiple-regression analysis, demographics, clinical factors, and pain were control variables, while anxiety (the SCARED score) and depressive symptoms (the MFQ score) were HRQOL (the PedsQL score) predictors. RESULTS:The regression model emerged with specified variables explaining 63 % of the variance in the PedsQL score (F = 11.92, p < 0.01) among children. Among parents, the same set of variables accounted for 49 % the variance (F = 6.99, p < 0.01). The MFQ score, but not the SCARED, added most to the variance. CONCLUSIONS:Depressive symptoms, but not anxiety, accounted for substantial variability in levels of HRQOL when considered with demographics, clinical factors, and pain. Thus, screening for depression needs to be considered as a part of multimodal assessment and treatment approaches in JIA.
Psychometric Properties of the Parent Version of the Revised Child Anxiety and Depression Scale in a Clinical Sample of Turkish Children and Adolescents.
Gormez Vahdet,Kilincaslan Ayse,Ebesutani Chad,Orengul A Cahid,Kaya Ilyas,Ceri Veysi,Nasiroglu Serhat,Filiz Mekiya,Chorpita Bruce F
Child psychiatry and human development
The Revised Child Anxiety and Depression Scale-Parent version (RCADS-P) is a self-report questionnaire that assesses dimensions of DSM-based anxiety and depressive disorders in children and adolescents. The present study examined the psychometric properties of the Turkish version in a clinical sample of 483 children and adolescents. The child and parent versions of the RCADS, parent versions of the Screen for Child Anxiety Related Emotional Disorders, the Strengths and Difficulties Questionnaire and Adolescent Symptom Inventory-Depression Scale were administered. Current psychiatric diagnoses were assessed via the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Version. The RCADS-P demonstrated high internal consistency and test-retest reliability, and good convergent, divergent, and discriminant validity. Confirmatory factor analysis supported the DSM-related six-factor structure. With its demonstrated favorable psychometric properties, the Turkish RCADS-P is currently the only validated parent-report instrument that assesses DSM-based anxiety and depressive disorders in children and adolescents in Turkey.
Trajectories of Social Anxiety in Children: Influence of Child Cortisol Reactivity and Parental Social Anxiety.
Poole Kristie L,Van Lieshout Ryan J,McHolm Angela E,Cunningham Charles E,Schmidt Louis A
Journal of abnormal child psychology
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 = 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.
Association between attention bias to threat and anxiety symptoms in children and adolescents.
Abend Rany,de Voogd Leone,Salemink Elske,Wiers Reinout W,Pérez-Edgar Koraly,Fitzgerald Amanda,White Lauren K,Salum Giovanni A,He Jie,Silverman Wendy K,Pettit Jeremy W,Pine Daniel S,Bar-Haim Yair
Depression and anxiety
BACKGROUND:Considerable research links threat-related attention biases to anxiety symptoms in adults, whereas extant findings on threat biases in youth are limited and mixed. Inconsistent findings may arise due to substantial methodological variability and limited sample sizes, emphasizing the need for systematic research on large samples. The aim of this report is to examine the association between threat bias and pediatric anxiety symptoms using standardized measures in a large, international, multi-site youth sample. METHODS:A total of 1,291 children and adolescents from seven research sites worldwide completed standardized attention bias assessment task (dot-probe task) and child anxiety symptoms measure (Screen for Child Anxiety Related Emotional Disorders). Using a dimensional approach to symptomatology, we conducted regression analyses predicting overall, and disorder-specific, anxiety symptoms severity, based on threat bias scores. RESULTS:Threat bias correlated positively with overall anxiety symptoms severity (ß = 0.078, P = .004). Furthermore, threat bias was positively associated specifically with social anxiety (ß = 0.072, P = .008) and school phobia (ß = 0.076, P = .006) symptoms severity, but not with panic, generalized anxiety, or separation anxiety symptoms. These associations were not moderated by age or gender. CONCLUSIONS:These findings indicate associations between threat bias and pediatric anxiety symptoms, and suggest that vigilance to external threats manifests more prominently in symptoms of social anxiety and school phobia, regardless of age and gender. These findings point to the role of attention bias to threat in anxiety, with implications for translational clinical research. The significance of applying standardized methods in multi-site collaborations for overcoming challenges inherent to clinical research is discussed.
Concordant parent-child reports of anxiety predict impairment in youth with functional abdominal pain.
Cunningham Natoshia R,Cohen Mitchell B,Farrell Michael K,Mezoff Adam G,Lynch-Jordan Anne,Kashikar-Zuck Susmita
Journal of pediatric gastroenterology and nutrition
BACKGROUND:Functional abdominal pain (FAP) is associated with significant anxiety and impairment. Prior investigations of child anxiety in youth with FAP are generally limited by small sample sizes, based on child report, and use lengthy diagnostic tools. It is unknown whether a brief anxiety-screening tool is feasible, whether parent and child reports of anxiety are congruent, and whether parent and child agreement of child anxiety corresponds to increased impairment. The purpose of this investigation was to examine anxiety characteristics in youth with FAP using parent and child reports. Parent-child agreement of child anxiety symptoms was examined in relation to pain and disability. METHODS:One hundred patients with FAP (8-18 years of age) recruited from pediatric gastroenterology clinics completed measures of pain intensity (Numeric Rating Scale) and disability (Functional Disability Inventory). Patients and caregivers both completed a measure of child anxiety characteristics (Screen for Child Anxiety and Related Disorders). RESULTS:Clinically significant anxiety symptoms were more commonly reported by youth (54%) than their parents (30%). Panic/somatic symptoms, generalized anxiety, and separation anxiety were most commonly endorsed by patients, whereas generalized anxiety, separation anxiety, and school avoidance were most commonly reported by parents. The majority (65%) of parents and children agreed on the presence (26%) or absence (39%) of clinically significant anxiety. Parent-child agreement of clinically significant anxiety was related to increased impairment. CONCLUSIONS:A brief screening instrument of parent and child reports of anxiety can provide clinically relevant information for comprehensive treatment planning in children with FAP.
A meta-analysis of the cross-cultural psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED).
Hale William W,Crocetti Elisabetta,Raaijmakers Quinten A W,Meeus Wim H J
Journal of child psychology and psychiatry, and allied disciplines
BACKGROUND:Accumulating studies have demonstrated that the Screen for Child Anxiety Related Emotional Disorders (SCARED), a modern youth anxiety questionnaire with scales explicitly designed to map onto specific DSM-IV-TR anxiety disorders, has good psychometric properties for children and adolescents from various countries. However, no study has yet been conducted as to the overall strength of the psychometric properties found in these studies. METHODS:Studies were collected from the PsycINFO, PubMed, SSCI, SCI-Expanded, ERIC, and A&HCI databases from the year of the SCARED's first publication (1997) to the present. The inclusion criteria focused on all studies that examined the psychometric properties of the SCARED. RESULTS:We retained 21 articles, reporting a total of 25 studies from predominantly Europe (Belgium, Germany, Italy, the Netherlands) and the USA, as well as South Africa and China, which matched our inclusion criteria. It was found that the psychometric properties were robust for the SCARED scales related to the symptoms of DSM-IV-TR anxiety disorders, that females scored significantly higher than males and that age had a moderating effect on male and female score differences. CONCLUSIONS:This meta-analysis suggests that the SCARED can be utilized as a screening instrument for DSM-IV-TR anxiety disorder symptom dimensions for children and adolescents from various countries.
Psychometric properties of the Persian version of the screen for child anxiety-related emotional disorders (SCARED).
Dehghani Fahimeh,Amiri Shole,Molavi Hossein,Neshat-Doost Hamid Taher
Journal of anxiety disorders
The present study examined the psychometric properties of the Persian translation of the Screen for Child Anxiety-Related Emotional Disorders-child version (SCARED-C) in a community sample of 557 children, aged 9-13 years, in the city of Isfahan, Iran. In addition to the SCARED-C, all the participants completed the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). The SCARED-C demonstrated moderate to high internal consistency (alpha=0.59-0.80) and good convergent and divergent validity. The one-factor and the five-factor model of the SCARED-C fitted the data moderately. However, the five-factor model had a significantly better fit than the one-factor model (Δχ(2)=287.346, df=10, P<.001). These findings showed that SCARED-C can be used as a reliable and valid measure of anxiety symptoms among children in Iran.
Brief Report: Testing the Psychometric Properties of the Spence Children's Anxiety Scale (SCAS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Autism Spectrum Disorder.
Carruthers Sophie,Kent Rachel,Hollocks Matthew J,Simonoff Emily
Journal of autism and developmental disorders
Anxiety is a prevalent and impairing co-morbidity among individuals with autism spectrum disorder (ASD), yet assessment measures, including screening tools, are seldom validated with autism samples. We explored the psychometric properties of the child and parent reports of the Spence Children's Anxiety Scale (SCAS) and the Screen for Anxiety Related Disorder-71 (SCARED-71) with 49 males with ASD (10-16 years, 63% co-occurring anxiety). Both measures had excellent internal consistency and fair-good parent-child agreement. The SCAS has a higher proportion of items evaluating observable behaviors. Predictive power of the measures did not differ. Higher cut-points in the parent reports (SCARED only) and lower cut-points in the child reports may enhance prediction in this sample. Choice of measure and cut-points should be considered alongside intended purpose.
The Screen for Child Anxiety-Related Emotional Disorders Is Sensitive but Not Specific in Identifying Anxiety in Children with High-Functioning Autism Spectrum Disorder: A Pilot Comparison to the Achenbach System of Empirically Based Assessment Scales.
Lohr W David,Daniels Katherine,Wiemken Tim,Williams P Gail,Kelley Robert R,Kuravackel Grace,Sears Lonnie
Frontiers in psychiatry
Validated brief screening instruments are needed to improve the detection of anxiety disorders in autism spectrum disorder (ASD). The Screen for Child Anxiety-Related Emotional Disorders (SCARED), a 41-item parent- and self-reported scale measuring anxiety, was compared to the Achenbach System of Empirically Based Assessment (ASEBA) scales. One hundred participants with a clinical diagnosis of high-functioning ASD, aged 8-18 years, and their parents completed the above scales. We hypothesized that the SCARED would be useful in screening for anxiety and its results for total scores of anxiety would converge with ASEBA syndrome scales for anxiety and internalizing disorders. Significant correlations were shown between the SCARED and the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) across a broad spectrum of scales. The CBCL syndrome scale for anxious/depressed showed the highest correlation and predicted anxiety scores on the SCARED. While many of the YSR scales significantly correlated with child ratings of anxiety, none of the scales predicted the SCARED child scores. Differences in self and parent reports suggest that parents interpret externalizing behaviors as signs of anxiety in ASD, whereas youth may describe internalized symptoms as anxiety. Females were more likely to self-report anxiety than males. Results support the use of the SCARED as a screening tool for anxiety in high-functioning ASD, but it should be supplemented with other tools to increase the specificity of its results.
Psychometric properties of the screen for child anxiety related emotional disorders for socially anxious and healthy Spanish adolescents.
Hale William W,Raaijmakers Quinten A W,García-López Luis Joaquín,Espinosa-Fernández Lourdes,Muela Jose Antonio,Díaz-Castela M del Mar
The Spanish journal of psychology
Socially anxious and healthy Spanish adolescents were studied in order to test the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED). Confirmatory factor analyses were employed to test measurement invariance between these two populations, Cronbach's alphas were calculated to determine the reliabilities of the scales, and partial eta-square tests calculated the effect size of the differences between socially anxious and healthy adolescents and between the adolescent boys and girls. The psychometric properties of the SCARED were good, as demonstrated by having acceptable reliabilities (ranging from .75 - .41) and a moderate multivariate effect size (η(p)(2) = .08) between the adolescent boys and girls. Most importantly, it was demonstrated that the SCARED could differentiate between socially anxious and healthy Spanish adolescents as demonstrated by measurement invariance (χ(2) = 254.27, df = 1343, GFI = .884, AGFI = .872, RMR = .031) and the large effect size (η(p)(2) = .22) between the samples.
[The German version of the "Screen for Child Anxiety Related Emotional Disorders" (SCARED): parent- and self report in a clinical sample].
Weitkamp Katharina,Romer Georg,Rosenthal Sandra,Wiegand-Grefe Silke,Daniels Judith
Praxis der Kinderpsychologie und Kinderpsychiatrie
The psychometric properties and cross-informant agreement of the German version of the "Screen for Child Anxiety Related Emotional Disorders" (SCARED) were assessed in a clinical sample. 77 children and adolescents aged 11 to 18 years in outpatient psychotherapy and 66 parents filled out the SCARED and Youth Self Report (YSR) or Child Behavior Checklist (CBCL), respectively. In n = 57 cases both parent and self-report was available. The German SCARED is shown to have good convergent and divergent validity compared with YSR/CBCL scales. The total score discriminated between children with an anxiety disorder and children with another psychiatric disorder. Cross-informant agreement was moderate with children reporting more and more severe anxiety symptoms than their parents. In conclusion, both the parent and the child version of the German SCARED proved valid. In clinical settings the integration of data from both perspectives seems important.
The psychometric properties of the screen for child anxiety related emotional disorders in pediatric chronic pain.
Jastrowski Mano Kristen E,Evans Jenny R,Tran Susan T,Anderson Khan Kim,Weisman Steven J,Hainsworth Keri R
Journal of pediatric psychology
OBJECTIVE:Examine the psychometric properties of the SCARED in pediatric chronic pain. METHODS:Participants were parents (n = 313 mothers, 163 fathers) and youth (n = 349) presenting for treatment of pediatric chronic pain. Participants completed the SCARED and measures of pain catastrophizing, internalizing problems, and health-related quality of life. RESULTS:Internal consistency (Cronbach's α) of SCARED Total scores ranged from .92 to .93 across sources of report. All subscales except for School Phobia exhibited good internal consistency. SCARED scores were significantly positively related to internalizing symptoms and pain catastrophizing; and negatively related to health-related quality of life. Confirmatory factor analysis revealed acceptable fit of the SCARED measurement model. CONCLUSIONS:The SCARED shows promise as a measure of anxiety in pediatric pain. Important caveats for its usage and areas in need of additional research are discussed. Of importance in pediatric pain is improving current approaches for measuring school anxiety in this population.
Examination of a cutoff score for the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a non-clinical Spanish population.
Canals Josefa,Hernández-Martínez Carmen,Cosi Sandra,Domènech Edelmira
Journal of anxiety disorders
We aimed to find a valid cutoff score for the Screen for Child Anxiety Related Emotional Disorders, child (SCARED-C) and parent (SCARED-P) Spanish versions for detecting Anxiety Disorders (AD) in a non-clinical population. The predictive accuracy of the SCARED-C and SCARED-P was assessed using the Area Under the Curve (AUC) of ROC curves. In general, the predictive accuracy of the SCARED-C (full version, short version, and four factors) was good and better than that of the SCARED-P. To differentiate between children who meet the diagnostic criteria for any AD and children who do not, we propose cutoff scores of 25 and 17 for the SCARED-C and SCARED-P, respectively. The sensitivities are 75.9% and 62.8%, and the specificities are 68.5% and 69.5%. The SCARED-C factor that had the best predictive accuracy was Somatic panic followed by Separation Anxiety, Generalized Anxiety and Social Phobia. The SCARED-P factor with the best predictive accuracy was Separation Anxiety. The results support the use of SCARED-C as a screening test for Anxiety disorders while SCARED-P should only be used as complementary information.
Diagnostic Efficiency of Caregiver Report on the SCARED for Identifying Youth Anxiety Disorders in Outpatient Settings.
Van Meter Anna R,You Dokyoung S,Halverson Tate,Youngstrom Eric A,Birmaher Boris,Fristad Mary A,Kowatch Robert A,Storfer-Isser Amy,Horwitz Sarah M,Frazier Thomas W,Arnold L Eugene,Findling Robert L,Lams Group The
Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53
This study investigated the diagnostic and clinical utility of the parent-rated Screen for Child Anxiety Related Emotional Disorders (SCARED-P) for detecting youth anxiety disorders. Youth ages 6 to 12 years, 11 months were recruited from 9 outpatient mental health clinics (N = 707). Consensus diagnoses were based on semistructured interviews (Schedule for Affective Disorders and Schizophrenia for School-Age Children) with youth and caregivers; 31% were diagnosed with at least one anxiety disorder. Caregivers completed the SCARED-P to describe youth anxiety levels. SCARED-P scores were not considered during the consensus diagnoses. Areas under the curve (AUCs) from receiver operating characteristic analyses and diagnostic likelihood ratios (DLRs) quantified performance of the SCARED-P total score and subscale scores (generalized anxiety disorder and separation anxiety disorder). SCARED-P total scores had variable efficiency (AUCs = .69-.88), and Generalized Anxiety Disorder and Separation Anxiety subscale scores were excellent (AUCs = .86-.89) for identifying specific anxiety disorders. Optimal subscale cutoff scores were computed to help rule in (DLRs = 2.7-5.4) or rule out (DLRs < 1.0) anxiety disorders among youth. Results suggest that the Generalized Anxiety Disorder and Separation Anxiety SCARED-P subscales accurately identify their respective matched diagnoses. DLRs may aid clinicians in screening for youth anxiety disorders and improve accuracy of diagnosis.
Sensitivity and specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a community-based study.
Desousa Diogo Araújo,Salum Giovanni Abrahão,Isolan Luciano Rassier,Manfro Gisele Gus
Child psychiatry and human development
The aim of this cross-sectional community-based study was to examine the sensitivity and specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED) to the diagnosis of anxiety disorders (AD). Participants were 119 students aged 9-18. Psychiatric diagnoses were assessed by a psychiatrist throughout a structural clinical interview (K-SADS-PL). Forty-four participants had positive diagnosis for at least one AD. The total score of the SCARED significantly differentiated anxious from non-anxious children with an optimal cutoff point of 22 (sensitivity = 81.8 %; specificity = 52.0 %). SCARED subscales of social phobia and separation anxiety disorder, but not generalized anxiety disorder, revealed better discrimination proprieties than total scores to screen for that specific disorder (p < .05). Both total and specific SCARED scores presented moderate sensitivity and specificity for detecting AD in a community sample. Investigators interested in screening for specific AD, rather than the group of AD, may benefit from using the specific subscales.
Reliability and validity of the Arabic Screen for Child Anxiety Related Emotional Disorders (SCARED) in a clinical sample.
Hariz Nayla,Bawab Souha,Atwi Mia,Tavitian Lucy,Zeinoun Pia,Khani Munir,Birmaher Boris,Nahas Ziad,Maalouf Fadi T
This study aimed at investigating the reliability and validity of the Arabic Screen for Child Anxiety Related Emotional Disorders (SCARED) as a first child and adolescent anxiety screening tool in the Arab World. The English parent (SCARED-P) and child (SCARED-C) versions were translated into Arabic and administered along with the Arabic Strengths and Difficulties Questionnaire (SDQ) to 77 parents and 67 children attending a Psychiatry clinic. DSM-IV-TR diagnoses were made by a psychiatrist without knowledge of the scale scores. Internal consistency was confirmed by Cronbach's α=0.92 for SCARED-P and 0.91 for SCARED-C. Their subscales had internal consistencies between 0.65 and 0.89. Parent-child agreement was r=0.67, p<0.001. SCARED-P demonstrated good discriminant validity between participants with anxiety disorders and those with other psychiatric disorders (t(72)=3.13, p=0.003). For SCARED-C, this difference was significant when participants with depressive disorders were excluded (t(43)=2.58, p=0.01). Convergent validity was evident through a significant correlation between SCARED-P and the parent SDQ emotional subscale (r=0.70, p<0.001), and SCARED-C and the child SDQ emotional subscale (r=0.70, p<0.001). Divergent validity with the SDQ hyperactivity subscale was observed as no significant correlation was found. Overall, the Arabic SCARED demonstrated satisfactory psychometric properties in a clinical sample in Lebanon.
Differences in Parent and Child Report on the Screen for Child Anxiety-Related Emotional Disorders (SCARED): Implications for Investigations of Social Anxiety in Adolescents.
Bowers Maureen E,Reider Lori B,Morales Santiago,Buzzell George A,Miller Natalie,Troller-Renfree Sonya V,Pine Daniel S,Henderson Heather A,Fox Nathan A
Journal of abnormal child psychology
Social anxiety typically emerges by adolescence and is one of the most common anxiety disorders. Many clinicians and researchers utilize the Screen for Child Anxiety Related Disorders (SCARED) to quantify anxiety symptoms, including social anxiety, throughout childhood and adolescence. The SCARED can be administered to both children and their parents, though reports from each informant tend to only moderately correlate. Here, we investigated parent-child concordance on the SCARED in a sample of adolescents (N = 360, M = 13.2) using a multi-trait multi-method (MTMM) model. Next, in a selected sample of the adolescents, we explored relations among child report, parent report, and latent social anxiety scores with two laboratory tasks known to elicit signs of social anxiety in the presence of unfamiliar peers: a speech task and a "Get to Know You" task. Findings reveal differences in variance of the SCARED accounted for by parent and child report. Parent report of social anxiety is a better predictor of anxiety signs elicited by a structured speech task, whereas child report of social anxiety is a better predictor of anxiety signs during the naturalistic conversation with unfamiliar peers. Moreover, while latent social anxiety scores predict both observed anxiety measures, parent report more closely resembles latent scores in relation to the speech task, whereas child report functions more similarly to latent scores in relation to the peer conversation. Thus, while latent scores relate to either observed anxiety measure, parent and child report on the SCARED each provide valuable information that differentially relate to naturalistic social anxiety-related behaviors.
Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Brazilian children and adolescents.
Isolan Luciano,Salum Giovanni Abrahão,Osowski Andrea Tochetto,Amaro Estácio,Manfro Gisele Gus
Journal of anxiety disorders
The aim of this study was to evaluate the psychometric properties of the Brazilian-Portuguese version of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a large community sample of Brazilian children and adolescents. A total of 2410 students completed the 41-item Brazilian-Portuguese version of the SCARED. The one-factor and the five-factor structure of the SCARED fit this sample well. However, the five-factor model had a significantly better fit than the one-factor model and an adequate fit for age and gender subgroups. Anxiety symptoms in Brazilian youth were reported at a moderate-high level as compared to other studies. Females were found to score significantly higher on the total score and on all of the subscales as compared to the males. The total score and each of the five factors for both children and adolescents showed good internal consistency, test-retest and construct validity. According to our findings the Brazilian-Portuguese version of the SCARED is a reliable and valid instrument to assess anxiety in Brazilian children and adolescents.
Anxiety Disorders among Adolescents in a Rural Area of Northern India using Screen for Child Anxiety-Related Emotional Disorders Tool: A Community-based Study.
Madasu Swapna,Malhotra Sumit,Kant Shashi,Sagar Rajesh,Mishra Ashwani Kumar,Misra Puneet,Ahamed Farhad
Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine
Background:Anxiety disorders are the most frequent mental disorders encountered in childhood and adolescent years. The number of epidemiological studies done in this area within India is limited. Objectives:We determined the prevalence of anxiety disorders among adolescents in a rural community of Ballabgarh block, district Faridabad, Haryana. Secondarily, we also assessed sociodemographic and other factors associated with anxiety disorders among adolescents. Materials and Methods:This community-based cross-sectional study was conducted among 729 adolescents (10-19 years). Screen for Child Anxiety-Related Emotional Disorders tool was used for assessing prevalence and type of anxiety disorders. Sociodemographic and personal factors were included in the logistic regression multivariable model to establish associations. Adjusted odds ratios (AOR) along with 95% confidence intervals (CI) are computed. Results:The prevalence of anxiety disorders among adolescents was (22.7%; 95% CI: 19.7-26.0). Girls (27.6%) had higher prevalence than boys (18.3%) ( < 0.01). Social anxiety disorder (14.3%; 95% CI: 11.7-16.9) was the most common form of anxiety disorder. Female sex (AOR 1.8; 95% CI 1.2-2.6; < 0.01), lower-middle socioeconomic status (AOR 1.96; 95% CI 1.2-3.1; < 0.01), and presence of stressful event within the past 1-year (AOR 2.48; 95% CI: 1.12-5.06; = 0.01) were found to be associated with the presence of anxiety disorders. Conclusions:Anxiety disorders are common among adolescents in rural settings of India. Tackling them will require appropriate health systems response. Adequate interventions should be incorporated at primary care level to address the mental health concerns of adolescents.
Psychometric Properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a Non-Clinical Sample of Children and Adolescents in Saudi Arabia.
Arab Arwa,El Keshky Mogeda,Hadwin Julie A
Child psychiatry and human development
This paper examined the reliability, convergent validity and factor structure of the self-report Screen for Child Anxiety Disorders (SCARED; Birmaher et al. in J Am Acad Child Adolesc Psychiatry 36:545-553, 1997) in a large community sample of children and adolescents in Saudi Arabia. The questionnaire showed moderate to high internal consistency and satisfactory test-retest reliability over a 2 week period. In addition, there were significant positive correlations between reported anxiety symptoms with parent report behavioural difficulties. The five factor structure model of the SCARED also had a good model fit in this population. The results showed that self-report anxiety symptoms decreased with age (for boys and not girls) and were higher in adolescent girls. The results suggest that the SCARED could be useful in this population to identify individuals who are at risk of developing anxiety disorders in childhood with a view to implementing prevention and intervention methods to ensure positive developmental outcome over time.
Screen for child anxiety related emotional disorders: are subscale scores reliable? A bifactor model analysis.
DeSousa Diogo Araújo,Zibetti Murilo Ricardo,Trentini Clarissa Marceli,Koller Silvia Helena,Manfro Gisele Gus,Salum Giovanni Abrahão
Journal of anxiety disorders
The aim of this study was to investigate the utility of creating and scoring subscales for the self-report version of the Screen for Child Anxiety Related Emotional Disorders (SCARED) by examining whether subscale scores provide reliable information after accounting for a general anxiety factor in a bifactor model analysis. A total of 2420 children aged 9-18 answered the SCARED in their schools. Results suggested adequate fit of the bifactor model. The SCARED score variance was hardly influenced by the specific domains after controlling for the common variance in the general factor. The explained common variance (ECV) for the general factor was large (63.96%). After accounting for the general total score (ωh=.83), subscale scores provided very little reliable information (ωh ranged from .005 to .04). Practitioners that use the SCARED should be careful when scoring and interpreting the instrument subscales since there is more common variance to them than specific variance.
Screening for childhood anxiety: A meta-analysis of the screen for child anxiety related emotional disorders.
Runyon Katie,Chesnut Steven R,Burley Hansel
Journal of affective disorders
BACKGROUND:The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a commonly used instrument that evaluates anxiety symptoms in children and adolescents. METHODS:This meta-analysis examined the psychometric properties of the SCARED instrument, including total instrument and subscale internal reliabilities for the parent and child versions, test-retest reliabilities, and the extent to which responses from the parent version correspond with responses from the child version. Databases reviewed included ERIC, PubMed, PsycINFO, ProQuest Dissertations and Theses, and Google Scholar RESULTS: Responses to the SCARED instrument for children and parents using a mixture of the 38-, 41-, 66-, 69-, and 71-item versions of the SCARED were analyzed for 65 studies conducted between 1997 and 2017. The results from the random-effects models suggested homogeneity of variance for all the effects examined. The weighted averages of the psychometric properties indicated the parent and child versions of the SCARED have exhibited excellent internal consistencies on the total score, panic disorder, generalized anxiety, separation anxiety, social anxiety, post-traumatic stress, and animal phobia subscales. Furthermore, the SCARED demonstrated moderate to large test-retest reliabilities and moderate to large parent-child agreement rates. The school avoidance, obsessive-compulsive disorder, blood phobia, and situational phobia subscales did not demonstrate reliabilities considered appropriate for a screening instrument. LIMITATIONS:Publications that could not be translated to English or could not be retrieved due to not being published or archived were not included in the analysis. CONCLUSIONS:Overall the child and parent versions of the SCARED have robust psychometric properties and perform consistently well in community and clinical settings across various countries. The SCARED is clinically relevant as mental health providers and researchers can use it during diagnostic procedures and to monitor intervention effectiveness.
The Validity of the Screen for Child Anxiety Related Emotional Disorders Revised (SCARED-R) Scale and Sub-Scales in Swedish Youth.
Ivarsson Tord,Skarphedinsson Gudmundur,Andersson Markus,Jarbin Håkan
Child psychiatry and human development
We evaluated the clinical utility of the Swedish SCARED-R in child- and adolescent psychiatric outpatients (n = 239) and validated it against Longitudinal Expert All Data (LEAD) DSM IV diagnoses based on the Children's Schedule for Affective Disorders and Schizophrenia (KSADS) and subsequent clinical work-up and treatment outcome. The SCARED-R total score and subscales had acceptable sensitivity/specificity for child and parent reports for cut-offs based on Receiver Operating Characteristics (ROC) curves, with mostly moderate area under the curve. Sensitivity ranged from 75% (parent rated social anxiety) to 79% [child rated Generalized Anxiety Disorder (GAD)]. Specificity, ranged from 60% for child-rated GAD to 88% for parent rated social anxiety. Parent-child agreement was moderate, and each informant provided unique information contributing to most diagnoses. In conclusion, the SCARED-R is useful for screening anxiety symptoms in clinical populations. However, it cannot replace interview based diagnoses, nor is it adequate to use just one informant.
The Screen for Child Anxiety Related Emotional Disorders (SCARED): Informant Discrepancy, Measurement Invariance, and Test-Retest Reliability.
Behrens Brigid,Swetlitz Caroline,Pine Daniel S,Pagliaccio David
Child psychiatry and human development
The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a measure widely used to assess childhood anxiety based on parent and child report. However, while the SCARED is a reliable, valid, and sensitive measure to screen for pediatric anxiety disorders, informant discrepancy can pose clinical and research challenges. The present study assesses informant discrepancy, measurement invariance, test-retest reliability, and external validity of the SCARED in 1092 anxious and healthy parent-child dyads. Our findings indicate that discrepancy does not vary systematically by the various clinical, demographic, and familial variables examined. There was support for strict measurement invariance, strong test-retest reliability, and adequate external validity with a clinician-rated measure of anxiety. These findings further support the utility of the SCARED in clinical and research settings, but low parent-child agreement highlights the need for further investigation of factors contributing to SCARED informant discrepancy.
Discriminant validity, diagnostic utility, and parent-child agreement on the Screen for Child Anxiety Related Emotional Disorders (SCARED) in treatment- and non-treatment-seeking youth.
Rappaport B I,Pagliaccio D,Pine D S,Klein D N,Jarcho J M
Journal of anxiety disorders
The Screen for Child Anxiety and Related Emotional Disorder (SCARED) may be differentially sensitive to detecting specific or comorbid anxiety diagnoses in treatment-seeking and non-treatment-seeking youth. We assessed the SCARED's discriminant validity, diagnostic utility, and informant agreement using parent- and self-report from healthy and treatment-seeking anxious youth (Study 1, N=585) and from non-treatment-seeking anxious youth (Study 2, N=331) diagnosed with generalized anxiety disorder (GAD), social anxiety disorder (SAD), or comorbid GAD+SAD. Among treatment-seeking youth, the SCARED showed good diagnostic utility and specificity, differentiating healthy, comorbid, and non-comorbid anxious youth. Child-parent agreement was modest: healthy child self-reports were higher than parent-reports whereas anxious child self-reports were similar or lower than parent-reports. Less consistent results emerged for diagnostic utility, specificity, and informant agreement among non-treatment-seeking youth. Given the number of non-treatment seeking anxious youth (N=33), generalizability of these findings may be limited. Together, results suggest informants may provide distinct information about children's anxiety symptoms.
Factor Structure of the Screen for Child Anxiety-Related Emotional Disorders (SCARED) in a Community Sample of Hong Kong Chinese Adolescents.
Chan Siu Mui,Leung Chi Hung
Child psychiatry and human development
The current study tested the factor structure of the 41-item SCARED in assessing anxiety in a sample of Hong Kong adolescents. Data were collected from 5,226 youths (54.5 % boys) aged 12-18. Results showed that the scale and the five subscales had high internal consistency. However, confirmatory factor analyses showed that the original five-factor model did not fit the data collected in this sample. Instead, the results revealed a seven-factor model consisting of one second-order factor of anxiety and seven first-order factors: the four original factors of General Anxiety, Panic/Somatic Syndromes, Social Anxiety, and School Phobia and three new factors representing different aspects of Separation Anxiety. Group invariance in the Boys and Girls models was found. It is recommended that the three new factors (Fear of Loneliness, Separation Fear, Worry about Harm) be further developed by adding new items so as to enhance the content and construct validities of the SCARED when used with Hong Kong adolescents.