Table 2.
Screening instruments for adolescent anxiety disorders
| Instrument | Age range | Description | Reliability/validity |
|---|---|---|---|
| Clinical interviews | |||
| Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions (ADIS-C/P)43 | 6–18 years | Semistructured interview. Assesses DSM-IV anxiety diagnoses via interview with child/adolescent and parent. Provides questions for symptoms as well as history of problems, cognitive and situational factors, and avoidance behaviors. Also provides diagnoses for comorbid diagnoses such as ADHD, conduct disorder, and depression. Takes 1–1.5 hours to administer. |
Test-retest reliability ranges from κ 0.43 (GAD in adolescents) to κ 0.92 (social phobia in children) |
| Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS)94 | 6–18 years | Semistructured interview. Assesses DSM-IV major disorders including anxiety, affective, behavioral, eating, psychotic, tics, substance abuse, elimination via child/adolescent and parent interview. Several versions are available including KSADS-P (present state version), KSADS-PL (present and lifetime version) and KSADS-E (epidemiologic version). Takes up to 1.25 hours to administer. |
Internal consistency α = 0.39 for all anxiety disorders combined, α > 0.75 for overanxious disorder and separation anxiety Test-retest reliability κ = 0.78 for overanxious disorder, κ = 0.80 for specific phobia |
| Composite International Diagnostic Interview (CIDI)95 | Children, adolescents, and adults | Standardized interview. Most recent version, 2.1, assesses DSM-IV and ICD-10 disorders. Paper and pencil and computerized versions available. Takes approximately 1.25 hours to administer. |
Interrater reliability κ ranged from 0.67–1.0, depending on the study and the disorder. Test-retest reliability ranged from 0.36–1.0, depending on the study, time frame, and disorder. Validity for syndromes κ ranged from 0.02–0.81. |
| Diagnostic Interview for Children and Adolescents (DICA)96,97 | 6–17 years | Semistructured interview. More structured than other semistructured interviews. Developed from the Diagnostic Interview Schedule (DIS), which assesses psychopathology in adults. Assesses DSM-III-R and DSM-IV diagnoses. Paper and pencil and computerized versions available. Takes 1–2 hours to administer. |
Test-retest reliability (κ) for DSM diagnoses ranges from 0.32 (ADHD in children) to 0.92 (conduct disorder in adolescents). |
| Child and Adolescent Psychiatry Assessment (CAPA)98 | 9–17 years | Semistructured interview. Assesses DSM-IV, DSM-III-R and ICD-10 diagnoses. Alternate versions expand the age range, including the Young Adult Psychiatry Assessment (YAPA) for ages 18+ and the Preschool-Age Psychiatry Assessment (PAPA) for ages 3–6 years. Takes 1–2 hours to administer. |
Test-retest reliability (κ) ranged from 0.55 (conduct disorder) to 1.0 (substance abuse/dependence) |
| Child Assessment Schedule (CAS)99 | 6–17 years | Semistructured interview. Assesses DSM-IV diagnoses. Questions are organized around 11 topics (school; friends; activities and hobbies; family; fears, worries, and anxieties; self-image; mood; physical complaints; anger; reality-testing). | Test-retest reliability (κ) reported for conduct disorder = 0.78, depression = 0.82, anxiety disorders = 0.72. Concurrent validity with KSADS reported to be acceptable. |
| Children’s Anxiety Evaluation Form (CAEF)100 | 7–17 years | Semistructured interview, chart review, and direct observation. Consists of three parts. First, available clinical notes are reviewed for the history of the illness. A checklist is provided to aid in the chart review. Second, a semistructured interview is conducted to elicit symptoms of anxiety in addition to their severity and frequency. Third, a checklist is used to evaluate observable symptoms of anxiety on a scale from 0–4. The overall CAEF score, ranging from 0–12, is a summary of global scores obtained from each of the three parts of the evaluation. |
Interrater reliability was 0.81 for total score, 0.73 for part 1, 0.86 for part 2, 0.87 for part 3. Significant correlations reported with the RCMAS and STAIC-trait scale. Able to distinguish between children diagnosed with anxiety disorders as compared with other psychiatric disorders. |
| Self-report measures | |||
| Multidimensional Anxiety Scale for Children (MASC)33 | 8–19 years | Assesses anxiety among four subscales: physical symptoms, social anxiety, harm avoidance, and separation/panic. Also includes an anxiety disorders index and total anxiety index. Thirty-nine items rated on a four-point Likert scale from 0–3. A 10-item version is also available. | Internal consistency varies. Most αs reported >0.80. However, in females, α ranged from 0.62–0.66 for avoidance and separation anxiety subscales. |
| Full measure takes approximately 15 minutes to complete. | Test-retest reliability ICC > 0.70 in most reported studies. Good discriminative validity reported. |
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| Screen for Childhood Anxiety Related Emotional Disorders (SCARED)38 | 9–18 years | Assesses anxiety within five factors: panic/somatic, generalized anxiety, separation anxiety, social phobia, and school phobia. Forty-one items rated on a three-point Likert scale from 0–2. Cutoff score of 25 indicates further evaluation for an anxiety disorder is needed. A five-item version of the scale is available and has similar psychometric properties to the original version. Takes 15 minutes to complete. |
Internal consistency α = 0.90 Good discriminate validity reported. |
| Revised Children’s Manifest Anxiety Scale (RCMAS)101 | 6–19 | Evaluates total anxiety as well as three subscales: physiological anxiety, worry, and social concerns/concentration. Also includes a lie scale. Thirty-seven items scored in a yes/no format. Updated version, RCMAS-2, includes social anxiety subscale instead of social concerns/concentration scale and a defensiveness and inconsistent responding index to improve upon the lie scale. A short form of the RCMAS-2 consisting of 10 items is also available. |
Internal consistency α > 0.80 in many studies. Test-retest reliability (r) for total scale ranged from 0.30 to 0.88. Reports of discriminate validity are mixed. |
| State-Trait Anxiety Inventory for Children (STAIC)102 | 8–14 | Full version takes approximately 15 minutes to complete. Measures state anxiety (short-term anxiety) and trait anxiety (general proneness towards anxiety) using two subscales. Each subscale consists of 20 items. Takes 10–15 minutes to complete. |
Internal consistency α > 0.80 in multiple studies. Test-retest reliability for state scale r = 0.65–0.71 and for trait scale r = 0.31–0.47. Reports of discriminate validity are mixed. |
| Social Phobia and Anxiety Inventory for Children (SPAI-C)103 | 8–14 | Evaluates cognitive, somatic, and behavioral components of social phobia. Twenty-six items, maximum score of 52. Cutoff score of 18 can distinguish between socially anxious and normal control children. Takes approximately 30 minutes to complete. |
Internal consistency α = 0.95 Test-retest reliability r = 0.85 |
| Social Anxiety Scale for Children-Revised (SASC-R)104 and Social Anxiety Scale for Adolescents (SAS-A)105 | 8–18 | Assesses social anxiety among three subscales: social avoidance and distress in new situations (SAD-N), social avoidance and distress in group situations (SAD-G), and fear of negative evaluation (FNE). Eighteen descriptive self-statements and four filler items, rated on a scale of 1–5. Takes 10–20 minutes to complete. |
Internal consistency for SAC-R subscales: SAD-N α = 0.70, SAD-G α = 0.69, FNE α = 0.86. Internal consistency for SAS-A: SAD-N α = 0.83, SAD-G α = 0.76, FNE α = 0.76. Test-retest reliability for SASC-R: SAD-N/FNE r > 0.70, SAD-G r < 0.55.(br)SAS-A: all r’s > 0.70. Good discriminate validity reported. |
| Parent/teacher report measures | |||
| Child Behavior Checklist (CBCL) and Teacher Report form (TRF)36 | 4–18 years | Assesses a range of internalizing and externalizing symptoms yielding subscales in withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior, and also broad internalizing and externalizing problems indexes. One hundred and eighteen items (CBCL) and 120 items (TRF) rated on three-point Likert scale. Takes 15–20 minutes to complete. |
Internal consistency for CBCL: α = 0.90 for internalizing and 0.94 for externalizing scale. Test-retest reliability for CBCL: r = 0.91 for internalizing scale and 0.92 for externalizing scale. |
| State-Trait Anxiety Inventory for Children-Parent Report-Trait Version (STAIC-P-T)37 | 8–14 years | Assesses parents’ perception of child’s trait anxiety (see STAIC above for more details). | |
| SCARED38 | 9–18 years | Assesses anxiety disorders among the same five factors as the self-report version (see SCARED above for more details). |