14-05-2016 | Original Article | Uitgave 1/2017 Open Access

The Youth Anxiety Measure for DSM-5 (YAM-5): Development and First Psychometric Evidence of a New Scale for Assessing Anxiety Disorders Symptoms of Children and Adolescents
- Tijdschrift:
- Child Psychiatry & Human Development > Uitgave 1/2017
Introduction
Method
Face Validity Checks
Suitability and Psychometric Properties of the YAM-5
Results
Initial Face Validity Check by Research Experts
Anxiety disorder item
|
Confirmation by research experts (%) (sensitivity)
|
Alternative anxiety disorder (%)
a (specificity)
|
Decision (reason)
|
---|---|---|---|
Separation anxiety disorder
|
|||
I am afraid to go anywhere without my parents
|
100
|
4.5
|
Retained: YAM-5-I item 1
|
I get frightened if my parents leave the house without me
|
100
|
6.8
|
Retained: YAM-5-I item 6
|
I am afraid that my parents will leave and never come back
|
100
|
0
|
Retained: YAM-5-I item 10
|
I am afraid that something bad will happen, so I’ll never see my parents again
|
100
|
4.5
|
Retained: YAM-5-I item 15
|
I am afraid if I am not at home
|
68.2
|
59.1 (SITAGO)
|
Removed (ambiguous item)
|
I want my father and mother to be with me when I go to sleep
|
100
|
13.6
|
Removed (no explicit anxiety)
|
I only want to sleep over at another kid’s home if my parents come
|
100
|
2.3
|
Removed (unlikely scenario)
|
I have very scary dreams that I lose my parents
|
100
|
0
|
Retained: YAM-5-I item 19
|
I don’t feel well when I have to go somewhere without my parents
|
100
|
0
|
Retained: YAM-5-I item 24
|
96.5
|
9.6
|
||
Selective mutism
|
|||
At school I don’t dare to talk to the teacher
|
86.4
|
59.1 (SOC)
|
Retained but changed: YAM-5-I item 2
|
If I meet someone I don’t know well, I don’t dare to say anything
|
77.3
|
68.2 (SOC)
|
Retained but changed: YAM-5-I item 11
|
If I come across someone who wants to talk to me, I don’t say anything back
|
93.2
|
36.4 (SOC)
|
Removed (redundant item)
|
At school I don’t dare to talk to the kids in my class
|
86.4
|
59.1 (SOC)
|
Retained but changed: YAM-5-I item 20
|
If there is a new visitor at our home, I won’t say anything
|
95.5
|
50.0 (SOC)
|
Retained but changed: YAM-5-I item 25
|
I am so afraid or shy that I don’t speak at all
|
95.5
|
22.7 (SOC)
|
Removed (partly measures temperament)
|
In the past I did not dare to say anything at school
|
93.2
|
38.7 (SOC)
|
Removed (measures past symptom)
|
In the past I did not dare to talk to strangers
|
84.1
|
59.1 (SOC)
|
Removed (measures past symptom)
|
89.0
|
49.2
|
||
Social anxiety disorder
|
|||
I find it scary to be with people I don’t know well
|
97.7
|
13.6
|
Retained but changed: YAM-5-I item 3
|
I find it very scary to talk with people I don’t know
|
95.5
|
36.4 (SM)
|
Removed (ambiguous/redundant item)
|
I find it scary to eat or drink if other people are looking at me
|
100
|
0
|
Retained: YAM-5-I item 7
|
I am afraid of being bullied at school
|
84.1
|
54.5 (GAD)
|
Removed (ambiguous item)
|
I find it very scary to act in a play
|
100
|
15.9 (SM)
|
Removed (not applicable to all children)
|
I am afraid that I will blush
|
100
|
9.1
|
Retained but changed: YAM-5-I item 12
|
I am afraid I’ll do something embarrassing
|
100
|
0
|
Retained: YAM-5-I item 16
|
I am very afraid that other kids don’t like me
|
100
|
22.7 (GAD)
|
Retained: YAM-5-I item 23
|
I am afraid that other people can see that I’m nervous
|
95.5
|
13.7 (PAN)
|
Removed (ambiguous item)
|
I am afraid I can’t get the words out
|
77.3
|
52.3 (SM)
|
Removed (ambiguous item)
|
I find it scary to give a speech in front of the class
|
100
|
13.6 (SM)
|
Retained but changed: YAM-5-I item 28
|
95.5
|
21.1
|
||
Panic disorder
|
|||
I panic for no reason
|
100
|
4.6
|
Retained: YAM-5-I item 4
|
I suffer from panic attacks
|
100
|
9.1
|
Retained but changed: YAM-5-I item 8
|
If I am afraid my heart beats very quickly
|
97.7
|
47.7 (All)
|
Retained but changed: YAM-5-I item 13
|
If I am afraid I sweat a lot
|
95.5
|
61.4 (All, SOC)
|
Removed (ambiguous item)
|
If I am scared I afraid to die
|
95.5
|
18.2
|
Retained but changed: YAM-5-I item 17
|
If I am afraid I shake a lot
|
95.5
|
50.0 (All)
|
Retained but changed: YAM-5-I item 21
|
If I am afraid I feel dizzy
|
100
|
31.8 (All)
|
Removed (less common symptom)
|
I am afraid of having a new anxiety or panic attack
|
97.7
|
13.6
|
Retained: YAM-5-I item 26
|
I am afraid that other people can see when I am panicking
|
68.2
|
63.6 (SOC)
|
Removed (ambiguous item)
|
In a big store I am afraid I will panic
|
65.9
|
70.5 (SITAGO)
|
Removed (ambiguous item)
|
91.6
|
37.1
|
||
Generalized anxiety disorder
|
|||
I worry about a lot of things
|
100
|
0
|
Retained: YAM-5-I item 5
|
I worry a lot
|
100
|
4.6
|
Removed (redundant item)
|
I think a lot about what can go wrong
|
100
|
11.4
|
Retained: YAM-5-I item 9
|
I worry about everything
|
100
|
0
|
Removed (redundant item)
|
I find it hard to stop worrying
|
100
|
0
|
Retained: YAM-5-I item 14
|
I worry a lot about how well I do things
|
90.9
|
25.0
|
Removed (ambiguous item)
|
I worry a lot about not doing well at school
|
93.2
|
13.7 (SOC)
|
Retained: YAM-5-I item 18
|
I worry a lot about disasters (for example earthquake, flood)
|
47.7
|
70.5 (NATENV)
|
Retained but changed: YAM-5-I item 22
|
I worry a lot about wars
|
90.9
|
11.4
|
Retained but changed: YAM-5-I item 22
|
I don’t feel well because I worry so much
|
100
|
0
|
Retained: YAM-I item 27
|
92.3
|
13.7
|
||
Specific phobia—animal type
|
|||
I am afraid of wasps
|
100
|
0
|
Retained: YAM-5-II item 1
|
I am afraid of dogs
|
100
|
0
|
Retained: YAM-5-II item 3
|
I am afraid of spiders
|
100
|
0
|
Retained: YAM-5-II item 9
|
I am afraid of snakes
|
100
|
0
|
Retained: YAM-5-II item 13
|
I am afraid of cats
|
100
|
0
|
Retained: YAM-5-II item 18
|
100
|
0
|
||
Specific phobia—natural environment type
|
|||
I am afraid of the dark
|
65.9
|
45.5 (SITAGO, OTH)
|
Retained: YAM-5-II item 4
|
I am afraid of standing on a high place
|
90.9
|
13.6 (SITAGO)
|
Retained but changed: YAM-II item 6
|
I am afraid of thunderstorms
|
93.2
|
6.8
|
Retained: YAM-5-II item 10
|
I am afraid to swim in deep water
|
97.7
|
2.3
|
Retained: YAM-5-II item 12
|
86.9
|
17.1
|
||
Specific phobia—blood–injection–injury type
|
|||
I am afraid of getting an injection
|
100
|
0
|
Retained: YAM-5-II item 11
|
I am afraid of getting a physical examination in the hospital
|
81.8
|
29.5
|
Retained but changed: YAM-II item 15
|
I am afraid of blood
|
100
|
0
|
Retained: YAM-5-II item 19
|
93.9
|
7.4
|
||
Specific phobia—situational type/Agoraphobia
|
|||
I am afraid to travel in an airplane
|
84.1
|
25.0 (OTH)
|
Retained: YAM-5-II item 5
|
I am afraid when crossing a large town square
|
90.9
|
11.4
|
Retained: YAM-5-II item 7
|
I am afraid of places with a lot of people
|
84.1
|
50.0 (SOC)
|
Retained but changed: YAM-5-II item 16
|
I am afraid when travelling by bus or train
|
97.7
|
13.6
|
Retained: YAM-5-II item 17
|
I am afraid when travelling by car
|
88.6
|
38.6 (GAD)
|
Removed (ambiguous/redundant item)
|
I am afraid to cross a long bridge
|
81.8
|
29.5 (NATENV)
|
Removed (ambiguous item)
|
I am afraid when sailing on a boat
|
77.3
|
38.6 (NATENV)
|
Removed (ambiguous item)
|
I am afraid to go in an elevator
|
93.2
|
15.9
|
Retained: YAM-5-II item 21
|
I am afraid to go outside on my own
|
68.2
|
68.2 (SEP)
|
Removed (ambiguous item)
|
I am afraid to go through a long tunnel
|
93.2
|
9.1
|
Retained: YAM-5-II item 22
|
85.9
|
30.0
|
||
Specific phobia—other type
|
|||
I am afraid of loud noises
|
77.3
|
25.0 (NATENV)
|
Retained: YAM-5-II item 2
|
I am afraid of people who are dressed up in costumes
|
95.5
|
6.8
|
Retained: YAM-5-II item 8
|
I am afraid that I have to vomit
|
70.5
|
38.6 (PAN/BII)
|
Retained but changed: YAM-5-II item 14
|
I am afraid that I will choke
|
50.0
|
54.5 (PAN)
|
Retained but changed: YAM-5-II item 20
|
73.3
|
31.2
|
Separation Anxiety Disorder
Selective Mutism
Social Anxiety Disorder
Panic Disorder
Generalized Anxiety Disorder
Specific Phobia: Animal Type
Specific Phobia: Natural Environment Type
Specific Phobia: Blood–Injection–Injury Type
Specific Phobia: Situational Type/Agoraphobia
Specific Phobia: Other Type
Construction of the Final Version of the Questionnaire
Second Face Validity Check by Clinicians
Anxiety disorder item (number in final scale)
|
Confirmation by clinicians (%) (sensitivity)
|
Alternative anxiety disorder (%)
a (specificity)
|
Item–total correlations and alpha subscale
|
Item–total correlations and alpha total scale
|
||
---|---|---|---|---|---|---|
Separation anxiety disorder
|
||||||
I am afraid to go anywhere without my parents (1)
|
97.1
|
2.9
|
0.44
|
0.53
|
0.54
|
0.52
|
I get frightened if my parents leave the house without me (6)
|
100
|
0
|
0.48
|
0.51
|
0.36
|
0.41
|
I am afraid that my parents will leave and never come back (10)
|
100
|
0
|
0.72
|
0.83
|
0.60
|
0.65
|
I am afraid that something bad will happen, so I’ll never see my parents again (15)
|
100
|
0
|
0.64
|
0.62
|
0.57
|
0.61
|
I have very scary dreams that I lose my parents (19)
|
94.1
|
5.9
|
0.51
|
0.68
|
0.47
|
0.55
|
I don’t feel well when I have to go somewhere without my parents (24)
|
97.1
|
2.9
|
0.63
|
0.54
|
0.55
|
0.60
|
98.0
|
2.0
|
0.80
|
0.84
|
|||
Selective mutism
|
||||||
At school I don’t speak to the teacher at all (2)
|
91.2
|
8.8
|
0.52
|
0.15
|
0.47
|
0.11
|
If I meet a new person, I don’t speak at all (11)
|
68.0
|
32.0 (SOC)
|
0.51
|
0.46
|
0.49
|
0.58
|
At school I don’t speak at all to the kids in my class (20)
|
82.4
|
17.6 (SOC)
|
0.38
|
0.35
|
0.32
|
0.37
|
I don’t speak at all when there is a new visitor at our home (25)
|
82.4
|
17.6 (SOC)
|
0.53
|
0.42
|
0.39
|
0.65
|
81.0
|
19.0
|
0.65
|
0.55
|
|||
Social anxiety disorder
|
||||||
I find it scary to meet new people (3)
|
100
|
0
|
0.67
|
0.64
|
0.72
|
0.45
|
I find it scary to eat or drink if other people are looking at me (7)
|
100
|
0
|
0.61
|
0.47
|
0.67
|
0.55
|
I am afraid that others will see that I blush (12)
|
100
|
0
|
0.54
|
0.44
|
0.51
|
0.48
|
I am afraid I’ll do something embarrassing (16)
|
100
|
0
|
0.63
|
0.62
|
0.64
|
0.59
|
I am very afraid that other kids don’t like me (23)
|
100
|
0
|
0.57
|
0.53
|
0.62
|
0.51
|
I am afraid that I might do or say something stupid in front of others (28)
|
100
|
0
|
0.46
|
0.71
|
0.52
|
0.66
|
100
|
0
|
0.81
|
0.81
|
|||
Panic disorder
|
||||||
I panic for no reason (4)
|
100
|
0
|
0.70
|
0.56
|
0.73
|
0.56
|
I suffer from anxiety or panic attacks (8)
|
97.1
|
2.9
|
0.70
|
0.62
|
0.66
|
0.46
|
All of a sudden I become so scared that my heart starts to beat very quickly (13)
|
97.1
|
2.9
|
0.33
|
0.60
|
0.40
|
0.58
|
When I panic, I am afraid that I could die (17)
|
100
|
0
|
0.30
|
0.63
|
0.35
|
0.50
|
I have severe anxiety attacks during which I tremble all over my body (21)
|
94.1
|
5.9
|
0.59
|
0.43
|
0.54
|
0.41
|
I am afraid of having a new anxiety or panic attack (26)
|
97.1
|
2.9
|
0.59
|
0.70
|
0.59
|
0.61
|
97.9
|
2.1
|
0.76
|
0.82
|
|||
Generalized anxiety disorder
|
||||||
I worry about a lot of things (5)
|
100
|
0
|
0.76
|
0.75
|
0.67
|
0.64
|
I think a lot about what can go wrong (9)
|
97.1
|
2.9
|
0.63
|
0.55
|
0.68
|
0.48
|
I find it hard to stop worrying (14)
|
100
|
0
|
0.80
|
0.66
|
0.68
|
0.49
|
I worry a lot about not doing well at school (18)
|
91.2
|
8.8
|
0.65
|
0.44
|
0.55
|
0.30
|
I worry a lot about all the bad things than happen in the world (22)
|
94.1
|
5.9
|
0.30
|
0.45
|
0.41
|
0.40
|
I don’t feel well because I worry so much (27)
|
100
|
0
|
0.71
|
0.73
|
0.67
|
0.60
|
97.1
|
2.9
|
0.85
|
0.83
|
|||
0.93
|
0.92
|
Phobia item (number in final scale)
|
Confirmation by clinicians (%) (sensitivity)
|
Alternative phobia (%)
a (specificity)
|
Item–total correlations and alpha subscale
|
Item–total correlations and alpha total scale
|
||
---|---|---|---|---|---|---|
Specific phobia—animal type
|
||||||
I am afraid of wasps (1)
|
100
|
0
|
0.53
|
0.42
|
0.61
|
0.51
|
I am afraid of dogs (3)
|
100
|
0
|
0.23
|
0.21
|
0.35
|
0.15
|
I am afraid of spiders (9)
|
100
|
0
|
0.44
|
0.39
|
0.48
|
0.56
|
I am afraid of snakes (13)
|
100
|
0
|
0.59
|
0.42
|
0.50
|
0.38
|
I am afraid of cats (18)
|
100
|
0
|
0.28
|
0.38
|
0.15
|
0.24
|
100
|
0
|
0.66
|
0.59
|
|||
Specific phobia—natural environment type
|
||||||
I am afraid of the dark (4)
|
64.7
|
35.3 (SITAGO)
|
0.51
|
0.37
|
0.67
|
0.49
|
I am afraid of heights (6)
|
76.5
|
23.5 (SITAGO)
|
0.17
|
0.38
|
0.25
|
0.41
|
I am afraid of thunderstorms (10)
|
97.1
|
2.9
|
0.21
|
0.48
|
0.47
|
0.49
|
I am afraid to swim in deep water (12)
|
82.4
|
17.6 (SITAGO)
|
0.21
|
0.33
|
0.30
|
0.55
|
80.2
|
19.8
|
0.47
|
0.61
|
|||
Specific phobia—blood–injection–injury type
|
||||||
I am afraid of getting an injection (11)
|
100
|
0
|
0.46
|
0.35
|
0.42
|
0.42
|
I am afraid of undergoing a small medical operation (15)
|
94.1
|
5.9
|
0.49
|
0.45
|
0.65
|
0.64
|
I am afraid of blood (19)
|
100
|
0
|
0.47
|
0.49
|
0.54
|
0.54
|
98.0
|
2.0
|
0.65
|
0.62
|
|||
Specific phobia—situational type/Agoraphobia
|
||||||
I am afraid to travel in an airplane (5)
|
91.2
|
8.8
|
0.51
|
0.42
|
0.52
|
0.58
|
I am afraid when crossing a large town square (7)
|
88.3
|
11.7
|
0.58
|
0.23
|
0.54
|
0.13
|
I am afraid of being in crowded places with lots of people (16)
|
100
|
0
|
0.51
|
0.68
|
0.48
|
0.58
|
I am afraid when travelling by bus or train (17)
|
85.3
|
14.7 (OTH)
|
0.51
|
0.55
|
0.41
|
0.50
|
I am afraid to go in an elevator (21)
|
88.3
|
11.7
|
0.37
|
0.42
|
0.41
|
0.50
|
I am afraid to go through a long tunnel (22)
|
91.2
|
8.8
|
0.52
|
0.49
|
0.51
|
0.43
|
90.8
|
9.2
|
0.74
|
0.67
|
|||
Specific phobia—other type
|
||||||
I am afraid of loud noises (2)
|
52.9
|
47.1 (NATENV, SITAGO)
|
0.19
|
0.30
|
0.39
|
0.44
|
I am afraid of people who are dressed up in costumes (8)
|
88.3
|
11.7 (SITAGO)
|
0.29
|
0.17
|
0.46
|
0.33
|
I am afraid that I will feel sick and have to vomit (14)
|
88.3
|
11.7
|
0.34
|
0.17
|
0.40
|
0.40
|
I am afraid choking when I eat or drink (20)
|
85.3
|
14.7 (SITAGO)
|
0.30
|
0.29
|
0.40
|
0.51
|
78.7
|
21.3
|
0.47
|
0.41
|
|||
0.86
|
0.86
|
Suitability
Reliability
Parent–Child Agreement
Parent version
|
Cronbach’s α (item–total
r’s)
|
Child version
|
r (parent–child)
‡
|
t value
|
|
---|---|---|---|---|---|
YAM-5-I anxiety disorders
|
15.38 (10.20)
|
0.91 (0.16–0.79)
|
17.21 (12.40)
|
0.69
|
1.59
|
Separation anxiety disorder
|
2.35 (2.70)
|
0.84 (0.44–0.71)
|
2.44 (3.06)
|
0.73
|
0.35
|
Selective mutism
|
2.04 (1.97)
|
0.64 (0.16–0.67)
|
2.22 (2.23)
|
0.42
|
0.61
|
Social anxiety disorder
|
4.03 (3.31)
|
0.85 (0.55–0.74)
|
4.71 (3.70)
|
0.67
|
1.89
|
Panic disorder
|
1.51 (2.26)
|
0.86 (0.51–0.76)
|
2.49 (3.14)
|
0.65
|
3.26**
|
Generalized anxiety disorder
|
5.44 (3.82)
|
0.87 (0.50–0.84)
|
5.33 (3.90)
|
0.68
|
−0.28
|
YAM-5-II phobias
|
10.02 (6.55)
|
0.77 (0.10–0.58)
|
11.71 (8.74)
|
0.70
|
2.16*
|
Animal type
|
4.02 (2.62)
|
0.47 (0.16–0.36)
|
4.00 (2.89)
|
0.61
|
−0.05
|
Natural environment type
|
1.86 (1.94)
|
0.53 (0.22–0.45)
|
2.44 (2.35)
|
0.55
|
2.25*
|
Blood–injection–injury type
|
2.13 (2.46)
|
0.86 (0.64–0.85)
|
2.05 (1.95)
|
0.64
|
−0.33
|
Situational type/agoraphobia
|
0.78 (1.16)
|
0.35 (0.12–0.26)
|
1.51 (2.15)
|
0.62
|
3.42**
|
Other type
|
1.24 (1.46)
|
0.41 (0.13–0.41)
|
1.71 (1.81)
|
0.58
|
2.47*
|
Validity
n
|
YAM-5 Child version
|
YAM-5 Parent version
|
|||
---|---|---|---|---|---|
I Anxiety disorders
|
II Phobias
|
I Anxiety disorders
|
II Phobias
|
||
SCID junior—anxiety symptoms
|
62
|
0.53**
|
0.39*
|
0.64**
|
0.36*
|
CBCL internalizing
|
55
|
0.31*
|
0.23
|
0.54**
|
0.32*
|
CBCL externalizing
|
55
|
−0.03
|
0.13
|
0.08
|
0.23
|
YSR internalizing
|
33
|
0.52*
|
0.12
|
0.28
|
0.04
|
YSR externalizing
|
33
|
−0.06
|
−0.18
|
−0.09
|
−0.09
|