Screen for Child Anxiety Related Emotional Disorders (SCARED)

The Screen for Child Anxiety Related Emotional Disorders (SCARED) was originally developed in the US as a child self-report (8-18year olds) and parent report instrument to screen children with anxiety disorders (Birmaher et al., 1997). An 85-item questionnaire based on the DSM-IV classification of anxiety disorders was generated. It was administered to 341 outpatient children and adolescents and 300 parents who were referrals to a mood/anxiety disorders clinic. Ages ranged from 9-18 years, 59% were female, 82% were Caucasian and 18% African-American. It was reduced to 38 items using item and factor analyses. The SCARED scales map onto specific DSM-IV-TR anxiety disorders, whereby 4 of the scales map directly onto Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Separation Anxiety Disorder (SAD), and Social Phobia (SP). The fifth scale is School Anxiety (SA), or School Refusal, while a serious anxiety problem, is not a DSM-IV-TR anxiety disorder (Hale, Crocetti, Raaijmakers, & Meeus, 2011). This is also the case for the DSM-5 (American Psychiatric Association, 2013).

The SCARED is a paper and pencil test; 10 mins to administer, can be immediately scored, simply by adding the items for each scale. The interpretation indicating which DSM-IV-TR anxiety disorder(s) is at the bottom of the form itself. There is no additional manual. There is a child and parent version of the same form. There are 3 answer choices to select to describe the child in the last 3 months; 0 = Not true or hardly ever true, 1 = Somewhat true or Sometimes true, and 2 = Very true or Often true. Example items:

Child version – When I get frightened it is hard to breathe.  I don’t like to be away from my family.

Parent version  – When my child feels frightened, it is hard for him/her to breathe. My child doesn’t like to be away from his/her family.

The child and parent SCARED both yielded five factors: somatic/panic, general anxiety, separation anxiety, social phobia and school phobia. For the total score and each of the five factors, both the child and parent SCARED demonstrated good internal consistency (α = .74 to .93), test-retest reliability (intraclass correlation coefficients = .70 to.90), discriminant validity (both between anxiety and other disorders and within anxiety disorders), and moderate parent-child agreement (r = .20 to .47, p < .001, all correlations) (Birmaher et al., 1997).

There were very few age, sex or race differences in both parent’ and children’s responses. In the child report, younger children (aged 9 to 12 years, n = 61) had significantly higher separation anxiety scores than older children (>12 years old, n = 280). However no age differences were found on parent report. The child and parent total anxiety scores, generalized anxiety, separation anxiety, panic, and school phobia factors were significantly higher in females than in males (all comparisons p < .05).

There were no significant race differences in the child SCARED. In the parent SCARED, African-American children had significantly higher scores on separation anxiety factor (3.8 ± 3.3 versus 2.6 ± 3.1, t1.297  = 2.0, p = .05, after Bonferroni correction) than Caucasians.

SCARED was further supported as a reliable and valid screening tool for clinically referred children and adolescents with anxiety disorders (Monga et al., 2000). It was tested against the Child Behaviour Checklist (CBCL) and the State-Trait Anxiety Inventory for Children (STAIC) to determine divergent and convergent validity. The SCARED correlated significantly better with the CBCL’s internalizing factors than with the externalising factors. Additionally, the parent and child forms of the SCARED correlated significantly with the trait and state subscales of the STAIC. Children with an anxiety disorder scored significantly higher on the SCARED than children with depression only or disruptive disorders only (P < 0.05), demonstrating its discriminant validity.

A meta-analysis of the cross-cultural psychometric properties of the SCARED reported on 25 studies predominately from Europe (Belgium, Germany, Italy, the Netherlands) the USA, South America and China. Psychometric properties were robust for the scales related to the symptoms of the DSM-IV-TR anxiety disorders, that females scored significantly higher than males and that age had a moderating effect on males and female score differences. The meta-analysis suggests that the SCARED can be used as a screening instrument for DSM-IV-TR anxiety disorder symptom dimensions for children and adolescents from various countries (Hale et al., 2011).

The SCARED is available at no cost at www.wpic.pitt.edu/research under tools and assessments, or at www.pediatricbipolar.pitt.edu under instruments. Intended users are clinicians and psychiatrists in screening 8-18 year olds with anxiety disorders. More recently the test has shown promise as a measure of anxiety in paediatric pain (Jastrowski et al., 2012).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–6. doi: 10.1097/00004583-199910000-00011

Birmaher, B., Khetarpal, S., Brent, D., Cully., Balach, L., Kaufman, J., & McKenzie  Neer, S.             (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry,36(4), 545-553. doi: 10.1097/00004583-199704000-00018

Hale, W. W., Crocetti, E., Raaijmakers, Q. A. W., & Meeus, W. H. J. (2011). 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

Jastrowski, M. K. E., Evans, J. R., Tran, S. T., Khan, K. A., Weisman, S. J., & Hainsworth, R. (2012). The psychometric properties of the screen for child anxiety related emotional disorders in pediatric chronic pain. Journal of Pediatric Psychology, 37(9), 999-1011. doi: 10.1093/jpepsy/jsso69

Monga, S., Birmaher, B., Chiappetta, L., Brent, D., Kaufman., 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: 10.1002/15206394(2000)12:2<85::aid-da4>3.0.co;2-2