Revised Children’s Anxiety and Depression Scale (RCADS)

Description
The Revised Children’s Anxiety and Depression Scale (RCADS; Chorpita, Yim, Moffitt, Umemoto & Francis, 2000) is a 47-item self report measure which assesses the frequency of anxiety and depression symptoms in youth aged 8-18 years.  The RCADS was developed in Hawaii, United States and is partly a revision of Spence’s Children’s Anxiety Scale (SCAS; 1997).  The measure has a parent-version form as well as a short-form (RCADS-25; Ebesutani et al., 2012). The RCADS is composed of 6 scales, 5 of which are related to anxiety (separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive compulsive disorder) and another one related to major depressive disorder. The scales are aligned with anxiety and depression diagnosis criteria in the DSM-IV. Individuals rate their answers on a 4-point likert scale ranging from “never” to “always”.  The results can be scored manually or via the scoring software created by the authors. In terms of results, T-scores greater than 65 are borderline clinically significant whereas those above 75 are clinically significant. These T-scores indicate that the individual’s responses reflect anxiety and depression-related symptoms very similar to those of individuals who meet diagnostic criteria for that particular disorder or syndrome.

Psychometrics
The RCADS has good internal consistency with Cronbach alpha values ranging from .78 for social anxiety disorder to .88 for panic disorder in a clinical population (Chorpita, Moffitt & Gray, 2005) as well as acceptable internal consistency in the general population (Chorpita et al.,2000).  Furthermore, the measure has good convergent validity with similar measures such as the Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978), the Children’s Depression Inventory (CDI) and interview dimensional ratings (Chorpita et al., 2005).  The RCADS also has favourable test-retest reliability for most scales with the social phobia scale being most reliable (0.80) and the obsessive compulsive disorder scale generally being the least reliable (0.65) when tested in a community sample of school children and adolescents (Chorpita et al., 2000). In terms of model fit, a study by Chorpita et al. (2005) using confirmatory factor analysis indicated an adequate model fit for a 6-factor model when compared to a 1 factor and a 2 factor model. The RCADS has been successfully validated in several countries including Australia (de Ross, Gullone & Chorpita,2002), Denmark (Esbjorn, Somhovd, Turnstedt & Reinholdt-Dunne, 2010), the Netherlands (Kosters, Chinapaw, Zwaanswijk, van der Wal & Koot, 2015) and Spain (Sandin, Valiente & Chorot, 2009) in clinical and school-based samples.

Use
The RCADS is available publicly and free of cost from www.childfirst.ucla.edu/resources.html. It can be used for both educational and professional purposes. However, if you want to use this tool for research purposes, permission is required from the authors. It’s a valuable tool for use with youth suspected of having an anxiety disorder or major depressive disorder as its scales reflect DSM-IV criteria and it’s one of the only anxiety measures that also measures depressive symptoms separately.  Furthermore, the RCADS has been translated into several languages including Spanish, Chinese and French and due to its cross-cultural validations, it can be used with youth from different cultures. It should be noted that the RCADS is only standardized for grades 3 and above as T-Score conversions have not been developed for children younger than grade three. Therefore, the authors recommend using clinical judgement for interpreting raw scores for these children.

 

References

Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour research and therapy43(3), 309-322.

Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour research and therapy38(8), 835-855.

de Ross, R. L., Gullone, E., & Chorpita, B. F. (2002). The revised child anxiety and depression scale: a psychometric investigation with Australian youth. Behaviour Change19(02), 90-101.

Ebesutani, C., Reise, S. P., Chorpita, B. F., Ale, C., Regan, J., Young, J., … & Weisz, J. R. (2012). The Revised Child Anxiety and Depression Scale-Short Version: Scale reduction via exploratory bifactor modeling of the broad anxiety factor. Psychological Assessment24(4), 833.

Esbjørn, B. H., Sømhovd, M. J., Turnstedt, C., & Reinholdt-Dunne, M. L. (2012). Assessing the Revised Child Anxiety and Depression Scale (RCADS) in a national sample of Danish youth aged 8–16 years. PLoS One7(5), e37339.

Kösters, M. P., Chinapaw, M. J., Zwaanswijk, M., van der Wal, M. F., & Koot, H. M. (2015). Structure, reliability, and validity of the revised child anxiety and depression scale (RCADS) in a multi-ethnic urban sample of Dutch children. BMC psychiatry15(1), 132.

Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A revised measure of children’s manifest anxiety. Journal of abnormal child psychology6(2), 271-280.

Sandín, B., Valiente, R. M., & Chorot, P. (2009). RCADS: evaluación de los síntomas de los trastornos de ansiedad y depresión en niñosy adolescentes. Revista de Psicopatología y Psicología Clínica14(3), 193-206.

Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour research and therapy36(5), 545-566.

Social Phobia Inventory (SPIN)

The Social Phobia Inventory (abbreviated as SPIN) is a 17-item questionnaire for screening and measuring severity of Social Anxiety Disorder (Social Phobia – SP). It was developed in 2000 by Connor et al. at the Psychiatry and Behavioral Sciences Department, Duke University, USA. At the time, available self-rated social phobia scales, did not assesses the spectrum of fear, avoidance, and physiological symptoms, all of which are clinically important. Because of this limitation, Social Phobia Inventory (SPIN) was developed. SPIN assess different aspects related to Social phobia – fear, avoidance, and physiologic symptoms. It is suitable for adult population (18+). Main application is for measuring change following pharmacological treatment. It also appears to be a useful screening tool for distinguishing between people with and without SP.

Example items:

I am afraid of people in authority

I am bothered by blushing in front of people

Parties and social events scare me

I avoid talking to people I don’t know

Each item is measured on a 5-point Likert scale, ranging from 0 (not at all) to 4 (extremely). Respondents indicate how much each item bothered them during the past week.  A categorical interpretation is suggested, were scores less than 20 are considered no SP, 21-30 mild SP, 31-40 moderate SP, 41-50 severe SP, and 51 or higher  very severe SP.

Psychometric properties

Results from the original validation study suggest that the SPIN possesses strong internal consistency (Full scale α 0.94, subscales -0.80-0.91), adequate test–retest reliability (r = 0.78), significant convergent validity with Brief Social Phobia Scale (r = 0.57, sub-scale r = 0.47-0.66), divergent validity across 3 measures ranged from r = 0.01- 0.34, adequate construct validity – was able to differentiate between subjects with and without social phobia (cut off score 19), also different levels of social phobia were reflected by different levels of SPIN scores.

Principal Component Factor analysis revealed 5 main factors –

  • Factor 1 reflected social inadequacy with fear and avoidance of talking to strangers and of social gatherings,
  • Factor 2 related to self-esteem identifying fear and avoidance of criticism,
  • Factor 3 identified physiological symptoms
  • Factor 4 reflected social inferiority with fear and avoidance of authority
  • Factor 5 loaded on avoidance of attention to oneself, specifically being centre of attention and public speaking.

However, there is preliminary support for both a 3-factor and a 5-factor structure. Further evaluation study by Antony et al., 2006, confirmed the original findings. They also stated that of the three proposed subscales on the SPIN, the physiological arousal subscale appeared to be the most limiting. Another study conducted with Brazilian university students also found SPIN to have excellent psychometric properties. Mini SPIN, a 3 – item questionnaire has also been found to have good sensitivity and specificity. SPIN can be accessed from – https://psychology-tools.com/spin/ . It is freely available.

References

Antony, M. M., Coons, M. J., McCabe, R. E., Ashbaugh, A., & Swinson, R. P. (2006). Psychometric properties of the social phobia inventory: Further evaluation. Behaviour research and therapy44(8), 1177-1185.

Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H., & FOA, E. (2000). Psychometric properties of the social phobia inventory (SPIN). The British Journal of Psychiatry176(4), 379-386.

Osório, F. L., Crippa, J. A. S., & Loureiro, S. R. (2010). Evaluation of the psychometric properties of the Social Phobia Inventory in university students. Comprehensive Psychiatry51(6), 630-640.

Ranta, K., Kaltiala-Heino, R., Koivisto, A. M., Tuomisto, M. T., Pelkonen, M., & Marttunen, M. (2007). Age and gender differences in social anxiety symptoms during adolescence: The Social Phobia Inventory (SPIN) as a measure. Psychiatry Research153(3), 261-270.

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