Screen for child anxiety related disorders

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-report screening questionnaire for anxiety disorders.[1] The questionnaire was developed by Boris Birmaher, Suneeta Khetarpal, Marlane Cully, David Brent, and Sandra Mackenzie in 1997.[1][2] The SCARED is a brief self-report instrument intended for youth, 8-18 years old, and their parents to complete in about 10 minutes,[3] and can discriminate between depression and anxiety, as well as among distinct anxiety disorders. It is recommended that the clinician explain all the questions to children 8-11 years old. The SCARED is useful for generalized anxiety disorder, social anxiety disorder, phobic disorders, and potentially school anxiety problems.[2] Most available self-report instruments that measure anxiety in children look at general aspects of anxiety rather than DSM categorizations.[4] The SCARED was developed as an instrument for both children and their parents that would encompass several DSM-IV categorizations of the anxiety disorders: somatic/panic, generalized anxiety, separation anxiety, social phobia, and school phobia.[4]

Screen for Child Anxiety Related Emotional Disorders, Revised
Medical diagnostics
SynonymsSCARED-R
LOINC62715-8
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Each question measures the frequency or intensity of a variety of symptoms or behaviors and the questionnaire takes about ten minutes to complete.[5] The participant is asked to answer each question with one of three possible answer choices: "Not true or hardly every true", "Somewhat true or sometimes true", or "Very true or often true".[6] Through research, this assessment has been found to be both valid and reliable in research settings.[1][3][4]

Recently the Screen for Child Related Anxiety Disorders was adapted in order to create the Screen for Adult Anxiety Related Disorders (SCAARED).[7] The SCAARED screens for four factors of anxiety related disorders; somatic/panic/agoraphobia, generalized anxiety, separation anxiety, and social anxiety. The SCAARED has shown excellent psychometrics properties and, because of it similarity to the SCARED, will be helpful in longitudinal studies that follow youth into adulthood, as well as studies that compare child and adult populations.[7]

Versions

The SCARED was developed in order to screen for anxiety disorders in children, therefore there is a parent version as well as a youth self-report version.[1]

The original version developed in 1997 was available in 38 items. The SCARED is most commonly used in the 41-item version published in 1999 which was updated with 3 additional items in the social phobia scale.[2] There is also a 66-item SCARED-Revised (SCARED-R) that includes the panic disorder, generalized anxiety disorder, social phobia, and separation anxiety disorder scales encompassing additional anxiety disorder symptoms.[2] The PhenX Toolkit uses SCARED-R as its child protocol Anxiety Disorders Screener.[8]

Reliability
Rubric for evaluating norms and reliability for the Screen for Child Anxiety Related Disorders [9]
CriterionRating (adequate, good, excellent, too good*)Explanation with references
NormsGoodMultiple research studies of large relevant clinical samples.[1]
Internal consistency (Cronbach's alpha, split half, etc.)GoodAlphas ranging from .74 to .89[1]
Inter-rater reliabilityNot publishedNo published studies formally checking inter-rater reliability
Test-retest reliability (stabilityAdequater = .86 over a median of 5 weeks[1]
RepeatabilityNot publishedNo published studies formally checking repeatability

Validity
Evaluation of validity and utility for the Screen for Child Anxiety Related Disorders [9]
CriterionRating (adequate, good, excellent, too good*)Explanation with references
Content validityExcellentCovers DSM diagnostic symptoms for anxiety disorders and specific phobias.[3]
Construct validity (e.g., predictive, concurrent, convergent, and discriminant validity)ExcellentShows convergent validity with other symptom scales. SCARED significantly positively correlated with CBCL.[4]
Discriminative validityGoodAUC of .67, able to discriminate between children with anxiety versus non-anxiety disorders in clinical settings, as well as individual types of anxiety disorders.[4]
Validity generalizationGoodUsed in clinical settings for children and adolescents ages 9–18. Reliable across genders and ethnicities. SCARED has been translated into multiple languages with good reliability[1][3]
Treatment responsivityGoodStudies show sensitivity to treatment effects when children took the SCARED pre and post treatment suggesting the assessment is effective in both clinical and research settings[10]
Clinical utilityGoodFree (public domain)

Development and history

Prior to the development of the SCARED, three rating scales were used to measure anxiety in children and adolescents: the Revised Children's Manifest Anxiety Scale,[11] the Revised Fear Survey Schedule for Children,[12] and the Somatic State and Trait Anxiety Scale.[13] While these methods were useful in assessing general anxiety symptoms, they were unable to discriminate between anxiety disorders. To address this shortcoming, the SCARED was developed based on DSM-IV classification to screen specifically for general anxiety disorder (GAD), separation anxiety disorder (SAD), panic disorder, social phobia, and school phobia.[1]

Impact

The SCARED has impacted the field of psychology by providing an assessment that is able to successfully detect anxiety disorders in children as well as differentiate between depression and anxiety and specific anxiety and phobia disorders.[3] The assessment should not be used alone in order to diagnose a child with an anxiety disorder, however research suggest it is a reliable and useful tool when used along with clinical interviewing in order to successfully diagnose anxiety disorders. The SCARED's good treatment sensitivity means that it is useful in both clinical and research settings to measure symptoms and presence of anxiety longitudinally, specifically over the course of treatment. It has also proved to be a useful tool in studying the effectiveness of certain treatments of anxiety disorders in children.[3]

Use in other populations

Studies of the SCARED also indicate good psychometric properties for children and adolescents of different cultures, distinguishing itself from other similar questionnaires.[2] The SCARED has been found to be a reliable assessment tool in several different cultures and translated into many different languages, including, but not limited to, French, German,[14] Italian, Dutch,[15] Spanish, Chinese, Arabic, and Thai.[2][16]

Limitations

The main limitation of this study is that it is a self-report measure which means that answers and results may be biased. Another limitation is that one version is filled out by a child and depending on the age and maturity of the child they may have trouble recognizing the frequency or severity of both external and internal symptom presentation. The parent may also be limited in recognizing the internal symptoms of their child's anxiety.[1]

SCARED PDFs and automated scoring

Pen and paper versions with scoring directions attached

Automated scoring for PCs

Automated scoring for MACs

Translations

See also
  • Diagnostic classification and rating scales used in psychiatry
  • Anxiety
  • Angulo, Melina; Rooks, Brian T.; Gill, Marykay; Goldstein, Tina; Sakolsky, Dara; Goldstein, Benjamin; Monk, Kelly; Hickey, Mary Beth; Diler, Rasim S.; Hafeman, Danella; Merranko, John; Axelson, David; Birmaher, Boris (2017). "Psychometrics of the screen for adult anxiety related disorders (SCAARED)- A new scale for the assessment of DSM-5 anxiety disorders". Psychiatry Research. 253: 84–90. doi:10.1016/j.psychres.2017.02.034. PMC 5472098. PMID 28359032.
  • Society of Clinical Child and Adolescent Psychology
  • EffectiveChildTherapy.Org information on fear, worry, and anxiety

References
  1. Birmaher, Boris; Khetarpal, Suneeta; Brent, David; Cully, Marlane; Balach, Lisa; Kaufman, Joan; Neer, Sandra McKenzie (1997). "The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale Construction and Psychometric Characteristics". Journal of the American Academy of Child & Adolescent Psychiatry. 36 (4): 545–553. doi:10.1097/00004583-199704000-00018. PMID 9100430.
  2. Hale, William W., III; Crocetti, Elisabetta; Raaijmakers, Quinten A.W.; Meeus, Wim H.J. (2011-01-01). "A meta-analysis of the cross-cultural psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED)". Journal of Child Psychology and Psychiatry. 52 (1): 80–90. doi:10.1111/j.1469-7610.2010.02285.x. ISSN 1469-7610. PMID 20662993.
  3. Birmaher, Boris; Brent, David A.; Chiappetta, Laurel; Bridge, Jeffrey; Monga, Suneeta; Baugher, Marianne (1999). "Psychometric Properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A Replication Study". Journal of the American Academy of Child & Adolescent Psychiatry. 38 (10): 1230–1236. doi:10.1097/00004583-199910000-00011. PMID 10517055.
  4. Monga S, Birmaher B, Chiappetta L, Brent D, Kaufman J, Bridge J, Cully M (2000). "Screen for Child Anxiety-Related Emotional Disorders (SCARED): Convergent and divergent validity". Depression and Anxiety. 12 (2): 85–91. doi:10.1002/1520-6394(2000)12:2<85::aid-da4>3.0.co;2-2. PMID 11091931.
  5. Osborn, J; Gately, B (13 January 2014). "SCARED-child – Screen for child anxiety related disorders – Child version".
  6. "Screen for Child Anxiety Related Disorders (SCARED): Child Version" (PDF). Department of Psychiatry, University of Pittsburgh. 27 March 2012.
  7. Angulo, Melina; Rooks, Brian T.; Gill, MaryKay; Goldstein, Tina; Sakolsky, Dara; Goldstein, Benjamin; Monk, Kelly; Hickey, Mary Beth; Diler, Rasim S. (2017). "Psychometrics of the Screen for Adult Anxiety Related Disorders (SCAARED)- A New Scale for the Assessment of DSM-5 Anxiety Disorders". Psychiatry Research. 253: 84–90. doi:10.1016/j.psychres.2017.02.034. PMC 5472098. PMID 28359032.
  8. "Protocol Overview: Anxiety Disorders Screener – Child". PhenX Toolkit, Ver 19.0. RTI International. January 17, 2017.
  9. Table from Youngstrom et al., unpublished, extending Hunsley & Mash, 2008
  10. Muris, Peter; Merckelbach, Harald; Gadet, Björn; Moulaert, Véronique; Tierney, Sandy (December 1999). "Sensitivity for Treatment Effects of the Screen for Child Anxiety Related Emotional Disorders". Journal of Psychopathology and Behavioral Assessment. 21 (4): 323–335. doi:10.1023/A:1022120832187. ISSN 0882-2689.
  11. Reynolds. "The Revised Children's Manifest Anxiety Scale" (PDF).
  12. Ollendick (2006). "Appendix III: Fear Survey Schedule for Children-Revised" (PDF). Fear Survey Schedule for Children- Revised. pp. 322–328. doi:10.1002/9780470713334.app3. ISBN 9780470713334.
  13. Grös, Daniel F.; Antony, Martin M.; Simms, Leonard J.; McCabe, Randi E. (2007). "Psychometric properties of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): Comparison to the State-Trait Anxiety Inventory (STAI)". Psychological Assessment. 19 (4): 369–381. doi:10.1037/1040-3590.19.4.369. PMID 18085930.
  14. Weitkamp, Katharina; Romer, Georg; Rosenthal, Sandra; Wiegand-Grefe, Silke; Daniels, Judith (2010-01-01). "German Screen for Child Anxiety Related Emotional Disorders (SCARED): Reliability, Validity, and Cross-Informant Agreement in a Clinical Sample". Child and Adolescent Psychiatry and Mental Health. 4: 19. doi:10.1186/1753-2000-4-19. ISSN 1753-2000. PMC 2912250. PMID 20591137.
  15. HALE, WILLIAM W; RAAIJMAKERS, QUINTEN; MURIS, PETER; MEEUS, WIM (2005). "Psychometric Properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in the General Adolescent Population". Journal of the American Academy of Child & Adolescent Psychiatry. 44 (3): 283–290. doi:10.1097/00004583-200503000-00013. PMID 15725973.
  16. "Screen for Child Anxiety Related Disorders (SCARED)".
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