An analysis of the RCMAS lie scale in a clinic sample of anxious children

Abstract

Examined Revised Children's Manifest Anxiety Scale (RCMAS) Lie scores in a sample of 284 anxious children. Lie scores were examined in relation to children's age, ethnicity/race, and gender, and in relation to Total Anxiety scores. The utility of Lie scores also was examined in terms of whether they were predictive of children's anxiety levels as rated by children themselves, parents, and clinicians. Between-group differences in children's Lie scores were examined as well. Results indicated that younger children had significantly higher Lie scores than older children, and Hispanic American children had significantly higher Lie scores than European American children. There were no significant gender differences in Lie scores, and no significant relation was found between RCMAS Lie scores and Total Anxiety scores for the total sample. Subgroup analyses indicated that Lie scores were predictive of children's anxiety levels. Results also indicated that Lie scores were significantly different between children who presented with anxiety disorders and children who presented with anxiety and externalizing disorders. Findings are discussed in terms of the usefulness of RCMAS Lie scores.

Introduction

The Revised Children's Manifest Anxiety Scale (RCMAS) is one of the most frequently used anxiety self-report measures in childhood anxiety research, with ample studies supporting its psychometric properties (see Reynolds & Richmond, 1985). Research findings further show that RCMAS Total Anxiety scores can be used for screening purposes and are sensitive to clinical change in treatment outcome research (e.g., Dadds et al., 1997, Kendall, 1994, Kendall et al., 1997, Silverman et al., 1999, Silverman et al., 1999). The RCMAS also offers another advantage that sets it apart from most other children's self-report measures in that the RCMAS contains not only a Total Anxiety scale but also a Lie scale. Containing items such as, “I never get angry,” “I like everyone I know,” and “I am always kind,” the Lie scale is often used as an indicator of social desirability Dadds et al., 1998, Reynolds & Richmond, 1985 and/or defensiveness Joiner, 1996, Joiner et al., 1996a, Joiner et al., 1996b, reflecting a tendency to present oneself in a favorable light, and/or deny flaws and weaknesses that others are usually willing to admit.

Despite the widespread use of the RCMAS in clinic and research settings, concerns have been raised about its diagnostic utility (or lack thereof), as RCMAS Total Anxiety scores have not been found to differ between diagnostic groups of children (e.g., children with anxiety disorders versus children with attention deficit hyperactivity disorder; Perrin & Last, 1992). This has spurred the development of new self-report measures of childhood anxiety, such as the Screen for Child Anxiety Related Emotional Disorders (SCARED; Birmaher et al., 1997) and the Multidimensional Anxiety Scale for Children (MASC; March, Parker, Sullivan, & Stallings, 1997). These new measures are welcome additions to the field, and are likely to play an increasingly important role in future research efforts. Nevertheless, because the RCMAS is likely to remain a widely used measure, this study investigated several issues with respect to it, focusing particularly on its Lie scale.

Thus, the purpose of the present study was to address the following issues with respect to the RCMAS; none of which have been addressed previously with clinic samples of anxious children. First, we examined whether Lie scores vary as a function of certain child characteristics, including gender, age, and ethnicity/race. Second, we examined the relation between Lie scores and Total Anxiety scores in different subgroups of children (e.g., younger, older, boys, girls, European American, and Hispanic American). Third, we examined whether Lie scores are predictive of the child's anxiety. Finally, we examined between-group differences in children's Lie scores in terms of primary diagnoses and patterns of comorbid diagnoses. Some background information follows with respect to each of these issues.

Most of the studies that have examined RCMAS Lie scores and child characteristics have used community samples. These studies found no significant mean differences in Lie scores as a function of gender Hagborg, 1991, Reynolds & Richmond, 1978. A recent community study conducted in Queensland, Australia, however, found that among younger children only, girls had significantly higher RCMAS Lie scores than boys (Dadds et al., 1998). In terms of age, community studies have found that younger children have significantly higher RCMAS Lie scores than older children Dadds et al., 1998, Reynolds & Richmond, 1978. In terms of ethnicity/race, community studies have found that African American children have significantly higher Lie scores than European American children (Reynolds & Richmond, 1978). No study has examined, however, whether Lie scores vary in other ethnic/racial groups, such as Hispanics. This study therefore contributes to the empirical/clinical research literature by examining whether Lie scale scores varied between boys and girls, younger and older children, and between European American and Hispanic American children, using a clinic sample of anxious children. If differences do emerge in children's Lie scores as a function of any of the above child characteristics (e.g., younger children), then this would suggest that clinicians may need to either consider, or place increased emphasis on, alternative sources when assessing child anxiety for a child who possesses that particular characteristic.

In terms of the relation between RCMAS Lie and Total Anxiety scores, studies with community samples have found no significant relation between the two (e.g., Dadds et al., 1998, Hagborg, 1991, Reynolds, 1982). We are aware of only one clinic study that reported on the relation between the RCMAS Lie and Total Anxiety scale scores (Joiner et al., 1996b). Joiner et al. (1996b) used a sample of child and adolescent psychiatric inpatients (N=96; ages 8 to 16 years) for whom depressive disorders, disruptive disorders, and anxiety disorders were most prevalent (44.7%, 13.7%, and 11.8%, respectively). A statistically significant negative correlation (r=−.21) was found between the RCMAS Lie and Total Anxiety scores.

Because clinicians and researchers who use the RCMAS usually obtain a Total Anxiety score and a Lie score for each youngster, we were interested in examining the relation between Lie scores and Total Anxiety scores for the total sample and for different subgroups of children (e.g., younger, older, boys, girls, European American, and Hispanic American). Examining this issue was of interest because it has been suggested high Lie scores are to be viewed as indicators of social desirability and/or defensiveness. (i.e., Dadds et al., 1998, Joiner, 1996, Joiner et al., 1996a, Joiner et al., 1996b, Reynolds & Richmond, 1985). Moreover, knowing whether Lie scores and Total Anxiety scores are negatively related is useful information because it may be that children who report elevated Lie scores underreport their anxiety, in which case clinicians and researchers may want to rely more on the information reported by other sources such as parents and/or teachers.

We are aware of only one study that examined whether RCMAS Lie scale scores are useful in predicting children's levels of anxiety (Dadds et al., 1998). Using a large community sample (N=1786; ages 7–14 years), Dadds et al. (1998) asked children to complete the RCMAS, and teachers to rate the children as anxious or not anxious. Results indicated that, for girls only, both RCMAS Total Anxiety and Lie scores were predictive of teachers' ratings of “anxious” and “non-anxious” children. The findings of Dadds et al. provide important initial information about the potential utility of the RCMAS Lie scores in that they showed that Lie scores are predictive of how other sources (i.e., teacher) view these children in terms of anxiety (e.g., present/absent).

Similar to Dadds et al. (1998), we were interested in examining whether RCMAS Lie scores would predict children's self-rated anxiety levels beyond parents' ratings of their children's anxiety levels. We examined this issue with parents as they are the ones (usually mothers) who seek help for their children's problems in clinic settings and who are generally most involved in the assessment process. If RCMAS Lie scores are found to be predictive of children's self-rated anxiety levels beyond parents' ratings of their children's anxiety levels, this would provide additional evidence that RCMAS Lie scores are meaningful. More specifically it would suggest that despite reporting low levels of anxiety, if a child's Lie score is elevated, the child can be anxious, as corroborated by the parent.

The utility of the RCMAS's Lie scale was also examined by evaluating between-group differences with respect to children's and parents' Total Anxiety and Lie scores using the RCMAS and the RCMAS-Parent version (RCMAS-P), respectively, across primary diagnoses and patterns of comorbid diagnoses. Although studies have examined this issue in regard to the RCMAS Total Anxiety scale and have not found significant differences between groups (e.g., anxiety disorders versus attention deficit hyperactivity disorder; Perrin & Last, 1992), there has been no attempt to explore the utility of the Lie scale using the most current diagnostic classification system, the DSM-IV (APA, 1994).

As far as we know, no study has examined whether there are any differences between the Lie scale scores of children who present with various anxiety disorders. Examining whether Lie scores are different across disorders is important as a way to determine whether the scale has utility in assisting differential diagnosis. Thus, in the present study we compared children's and parents' Total Anxiety and Lie scores for the following diagnostic groups: specific phobias, overanxious and/or generalized anxiety disorder, separation anxiety disorder, and social phobia. Although we might hypothesize that children with social anxiety-based disorders (i.e., overanxious and/or generalized anxiety disorder and social phobia) would have higher Lie scale scores than children with specific phobias and separation anxiety disorder, in light of the absence of previous research on this issue, we note the exploratory quality of this hypothesis. In addition, we examined whether Lie scale scores were different for children with various comorbid patterns; namely, comorbid anxiety disorders, comorbid anxiety+disruptive disorders, and comorbid anxiety+depressive disorders. These particular comorbid patterns were studied in light of their high prevalence in youth (see Angold et al., 1999, Kovacs & Devlin, 1998, Last et al., 1992), though these analyses also were viewed as primarily exploratory in nature.