Correlations among two self-report questionnaires for measuring DSM-defined anxiety disorder symptoms in children: the Screen for Child Anxiety Related Emotional Disorders and the Spence Children’s Anxiety Scale
Introduction
It has long been recognized that symptoms of anxiety and true anxiety disorders are quite common in children and adolescents. Recent epidemiological studies have suggested that between 8 and 12% of children suffer from some type of anxiety disorder that is sufficiently severe to interfere with daily functioning (see, for comprehensive reviews, Bernstein et al., 1996, Craske, 1997).
In the past decade, researchers and clinicians have reached consensus on the various types of childhood anxiety disorders (American Academy of Child and Adolescent Psychiatry, 1997). According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-IV; American Psychiatric Association [APA], 1994) the following anxiety disorders in youths are discernable: (1) separation anxiety disorder is characterized by excessive anxiety concerning separation from the home or from significant attachment figures, to a degree that is beyond the child’s developmental level; (2) generalized anxiety disorder, formerly termed overanxious disorder (APA, 1987), refers to excessive anxiety and worry, accompanied by symptoms of motor tension and vigilance; (3) social phobia is concerned with marked and persistent fear of social or performance situations in which embarrassment may occur; (4) panic disorder is characterized by the presence of panic attacks (i.e., a discrete period of intense fear) accompanied by persistent concern about their recurrence or their consequences; (5) obsessive-compulsive disorder is characterized by the occurrence of obsessions, i.e., intrusive ideas, thoughts, images, or impulses that cause marked anxiety or distress, and compulsions, i.e., repetitive behaviours or mental acts which serve to neutralize anxiety; (6) specific phobia is characterized by marked and persistent anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour; and (7) acute stress disorder and posttraumatic stress disorder are both characterized by the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma.
Self-report questionnaires of childhood anxiety represent a time-efficient way to capture information about a wide range of anxiety symptoms. The three most widely used instruments for this purpose are the Revised Children’s Manifest Anxiety Scale (RCMAS: Reynolds & Richmond, 1978), the State-Trait Anxiety Inventory for Children (STAI-C: Spielberger, 1973), and the Fear Survey Schedule for Children—Revised (FSSC-R: Ollendick, 1983). One important shortcoming of these measures is that they are all indices of general anxiety and not keyed to the anxiety disorders listed in the DSM-IV.
The Screen for Child Anxiety Related Emotional Disorders (Birmaher et al., 1997, Muris et al., 1999b and the Spence Children’s Anxiety Scale (SCAS: Spence, 1997, Spence, 1998) are two recently developed self-report questionnaires that attempt to measure childhood anxiety symptoms in terms of the DSM-IV taxonomy. The questionnaires are not completely identical. The original SCARED developed by Birmaher et al. (1997) measures symptoms of generalized anxiety disorder, separation anxiety disorder, social phobia, panic disorder, and school phobia. Muris et al. (1999b) revised the SCARED by adding items that index obsessive-compulsive disorder, specific phobia (divided into three subtypes: animal phobia, blood-injection-injury phobia, and situational-environmental phobia), and traumatic stress disorder. Thus, the revised SCARED taps symptoms of the entire anxiety disorders spectrum listed in the DSM-IV. The SCAS measures the following anxiety disorders: generalized anxiety disorder, separation anxiety disorder, social phobia, panic disorder and agoraphobia, obsessive-compulsive disorder, and specific phobia represented by a subscale named ‘physical injury fears’.
Research has provided evidence for the reliability and validity of the SCARED and the SCAS. Both questionnaires seem to be reliable in terms of internal consistency and test-retest stability (Muris et al., 1999b; Muris, Merckelbach, Van Brakel & Mayer, 1999c; Spence, 1998). Furthermore, support has been found for the concurrent validity of both measures. For example, scores of the SCARED and SCAS correlate strongly with scores on traditional childhood anxiety measures such as the RCMAS, STAIC, and FSSC-R (Muris, Merckelbach, Van Brakel, Mayer & Van Dongen, 1998a; Muris, Merckelbach, Mayer, Van Brakel, Thissen, Moulaert & Gadet, 1998b; Spence, 1998). Finally, SCARED and SCAS also seem to possess discriminant validity. More specifically, there is evidence to suggest that SCARED and SCAS satisfactorily discriminate children with a specific anxiety disorder from children without that particular disorder (Birmaher et al., 1997, Spence, 1998).
The main purpose of the present study was to examine the relationship between SCARED and SCAS in a large sample of Dutch school children (N=1011). This was done in two ways. First of all, correlations between the anxiety disorder subscales of both questionnaires were computed. Second, a confirmatory factor analysis was carried out to examine to what extent corresponding SCARED and SCAS subscales load uniquely on latent factors that are in keeping with DSM-IV defined anxiety disorders.
Section snippets
Children
The sample consisted of 1011 children, 524 boys and 487 girls, from regular primary and secondary schools in South-Limburg, The Netherlands. Children had a mean age of 12.77 years, SD=2.48, range 7–19. No exact information about the socio-economic background, ethnicity, and family structure of the children was available. On the basis of information provided by the staff of the schools that participated in the present study, the percentages of children with low, middle, and upper socio-economic
Internal consistency
The internal consistency of the SCARED total anxiety score turned out to be good: Cronbach’s alpha was 0.94. The internal consistency of the SCARED subscales was also acceptable, with alphas of 0.81 for generalized anxiety disorder, 0.75 for separation anxiety disorder, 0.76 for social phobia, 0.81 for panic disorder, 0.66 for obsessive-compulsive disorder, 0.82 for animal phobia, 0.72 for blood-injection-injury phobia, 0.66 for situational-environmental phobia, and 0.81 for traumatic stress
Discussion
The present study examined correlations among two self-report questionnaires for measuring DSM-defined childhood anxiety disorder symptoms: the SCARED and the SCAS. Results showed that there was a strong correlation between the total anxiety scores of these instruments (r=0.89). Furthermore, most of the SCARED subscales were found to be convincingly connected to their SCAS counterparts. Finally, a confirmatory factor analysis revealed that SCARED and SCAS anxiety disorder subscales loaded
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