Reliability and validity of the Spence Children's Anxiety Scale and the Screen for Child Anxiety Related Emotional Disorders in German children

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Abstract

The reliability and validity of the Spence Children's Anxiety Scale (SCAS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) were evaluated in a sample of 556 German primary school children. Both the SCAS (alpha=0.92) and the SCARED (alpha=0.91) were demonstrated to have high internal consistency. The validity of the SCAS and the SCARED was supported by a number of findings. First, in agreement with previous studies, girls displayed significantly higher levels of anxiety symptoms than boys. Furthermore, SCAS and SCARED scores were substantially interrelated. Finally, significant correlations were found between these two measures of anxiety symptoms and the Youth Self-Report and the Columbia Impairment Scale. The utility of the SCAS and the SCARED as screening instruments for anxiety symptoms in children is briefly discussed.

Introduction

Anxiety disorders represent one of the most common psychiatric disorders in children and adolescents. Findings from epidemiological studies have shown that as many as 10% of the children and adolescents are affected by these disorders (Essau, Conradt, & Petermann, 2000; Essau & Petermann, 2001; Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993; McGee et al., 1990). Although some fears and anxieties are part of normal development, for some proportions of the children these problems, if left untreated, may persist through adolescence and adulthood (Cohen et al., 1993; Feehan, McGee, & Williams, 1993; Keller et al., 1992). Anxiety is associated with impairment in various life domains such as in school, leisure-time activities, and peer-interaction (Bowen, Offord, & Boyle, 1990; Essau et al., 2000; Kashani & Orvaschel, 1990; Ginsburg, La Greca, & Silverman, 1998). Studies have also indicated that the presence of anxiety symptoms may act as a risk factor for the development of various types of psychiatric disorders in adulthood, including depression and substance use disorders (Wittchen & Essau, 1994). These findings stress the importance to identify clinically anxious children at an early stage so that appropriate intervention can be provided. The realization of this aim, however, depends on the availability of instruments with sound psychometric properties. Structured diagnostic interviews are not practical as a screening instrument because they are too time consuming to administer, and usually require that the interviewers are well-trained in using the instrument (Essau & Barrett, 2001). By contrast, self-report questionnaires are more convenient, less expensive, and are easy to standardize.

Given these advantages, numerous self-report questionnaires for the assessment of anxiety symptoms in children and adolescents have been developed and examined in the literature. The most commonly used scales are the Fear Survey Schedule for Children-Revised (FSSC-R; Ollendick, 1983), the Revised Children's Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1985), and the State-Trait Anxiety Inventory for Children (STAIC; Spielberger, Gorsuch, & Luchene, 1976). Other instruments have been tailored to specific types of anxiety, including social anxiety and fear of negative evaluation (e.g., the Social Anxiety Scale for Children; LaGreca & Stone, 1993), and posttraumatic stress disorder (e.g., the PTSD Reaction Index; Frederick, 1985). While these questionnaires have sound psychometric properties, they cannot be used to measure symptoms of DSM-IV anxiety disorders. Two noteworthy exceptions in this respect are the Spence Children's Anxiety Scale (SCAS; Birmaher et al. (1997), Spence (1998)) and the Screen for Child Anxiety Related Emotional Disorders (SCARED; Birmaher et al. (1999), Birmaher et al. (1997)). Unlike other existing questionnaires (e.g., RCMAS or STAIC), the SCAS and the SCARED tap anxiety symptoms that can be specifically linked to DSM-IV anxiety disorders. The SCARED was developed within the context of samples in clinical settings (Birmaher et al., 1997), however, it has been used in non-referred school children (Muris, Schmidt, & Merckelbach, 2000). Although the development of the SCAS was based on community samples, this scale has also norms for clinically referred children (Birmaher et al. (1997), Spence (1998)). Recent studies have provided strong support for the psychometric properties of the SCAS and the SCARED (Birmaher et al., 1997; Muris, Merckelbach, van Brakel, Mayer, & van Dongen, 1998a; Muris et al., 2000; Birmaher et al. (1997), Spence (1998)). Strong correlations have also been reported between the SCAS and the SCARED with traditional measures of anxiety symptoms such as the RCMAS, STAIC, and the FSSC-R (Muris et al., 1998b; Spence, 1998).

The main purpose of the present study was to examine the reliability and the validity of the German translation of the SCAS and SCARED in primary school children. Such psychometric evaluation would indicate whether these two self-report questionnaires are useful for screening anxiety symptoms in normal population. Another purpose is to examine age and gender patterns of anxiety symptoms, and the relationship of anxiety symptoms with psychosocial functioning.

Section snippets

Participants

The sample consisted of 556 children (275 boys and 281 girls) who were enrolled in grades 3–6. Children's age ranged from 8 to 12 years (mean=10.6, SD=1.2). The participants were recruited from urban and rural primary schools in Niedersachen, Germany. Most of the children came from small families and were firstborn children. The vast majority of them came from intact families; about 80% of the children were living with both parents. The socioeconomic status of subjects varied greatly, ranging

Results

The means and standard deviations for the SCAS and the SCARED,1

Discussion

The main purpose of this article was to examine the reliability and validity of the SCAS and the SCARED in German children. Unlike other instruments that measure anxiety in youths, the SCAS and the SCARED contain items that can be linked to symptoms of DSM-IV anxiety disorders. Before discussing our findings, some limitations should be discussed. First, only 8–12 year olds were included in our study, so it is not clear whether our findings can be generalized to other populations (e.g.,

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