The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics

Phenomenology of depression in young girls

OBJECTIVE

To examine the prevalence of depressive symptoms, the overlap between caregiver and child report, the association between depression and anxiety, and the relationship between symptoms of depression and impairment in young girls.

METHOD

Participants in the Pittsburgh Girls Study, a community sample of 2,451 girls aged 5-8 years old and their primary caregivers were interviewed in 2000-2001 using the Child Symptom Inventory and the Short Moods and Feelings Questionnaire to measure depression, the Screen for Child Anxiety and Related Emotional Disorders to measure anxiety, and the Children's Global Assessment Scale to measure impairment.

RESULTS

Less than 1% of 5- to 8-year-old girls had five or more symptoms of major depression according to the caregiver report. Individual differences in symptom counts and depression scores by caregiver and child report were observed. Agreement between caregivers and girls on depression symptoms was low, with only 2% of the variance in caregiver-reported depression on the Child Symptom Inventory being accounted for by child report on the Short Moods and Feelings Questionnaire. The level of association between depression and anxiety scores suggested that these constructs are associated but relatively independent in young girls. Both caregiver report and child report of depressive symptoms were uniquely associated with impairment ratings.

CONCLUSIONS

Although major depression appears to be rare among 5- to 8-year-old girls, continuous measures of depressive symptoms yield significant individual differences that are associated with impairment. Thus, preliminary evidence suggests that depressive symptoms can be validly measured in 5- to 8-year-old girls.

[Diagnostic structured interviews in child and adolescent's psychiatry]

Structured diagnostic interviews, which evolved along the development of classification's systems, are now widely used in adult psychiatry, in the fields of clinical trials, epidemiological studies, academic research as well as, more recently, clinical practice. These instruments improved the reliability of the data collection and interrater reliability allowing greater homogenisation of the subjects taking part in clinical research, essential factor to ensure the reproducibility of the results. The diagnostic instruments, conversely to the clinical traditional diagnostic processes allow a systematic and exhaustive exploration of disorders, diagnostic criteria but also severity levels, and duration. The format of the data collection, including the order of exploration of the symptoms, is fixed. The formulation of the questions is tested to be univocal, in order to avoid confusions. In child and adolescent, researches in pharmacology and epidemiology increased a lot in the last decade and the standardisation of diagnostic procedures is becoming a key feature. This Article aims to make an assessment, a selection, and a description of the standardized instruments helping psychiatric diagnosis currently available in the field of child and adolescent's psychiatry. Medline and PsycINFO databases were exhaustively checked and the selection of the instruments was based on the review of four main criteria: i) compatibility with international diagnostic systems (DSM IV and/or ICD-10); ii) number of disorders explored; iii) peer reviewed Journals and iv) richness of psychometric data. After the analysis of the instruments described or mentioned in the literature, 2 structured interviews [the Diagnostic Interview Schedule for Children (DISC) and the Children's Interview for Psychiatric Syndromes (ChIPS)] and 4 diagnostic semi-structured interviews [the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS), the Diagnostic Interview for Children and Adolescent (DICA), the Child and Adolescent Psychiatric Assessment (CAPA) and the Interview Schedule for Children and Adolescents ISCA)] were retained according to the 3 first criteria. All can be administered by clinicians, and x out of 6 can also be administered by lay-interviewers. All include a child/adolescent version and a parent version. Two instruments evaluate the presence of DSM IV axe II disorders: The ISCA explores the criteria of the Antisocial Personality Disorder. The CAPA evaluates Borderline, Obsessional-compulsive, Histrionic and Schizotypic Personality Disorders. Regarding the psychometric quality criterion, the selection was much more difficult because of the lack of data and the weakness of the samples studied in reliability studies. Interrater reliability appeared to be good for the 6 instruments, with kappas ranging from 0.5 to 1. This is usual in such instruments. The test-retest reliability was found to vary from bad to excellent depending on the instruments, the "informant" status (child/adolescent or parent), and the disorder explored, kappas ranging from 0.32 to 1. The worst results concerned face-to-face reliability studies which showed weak concordances for the diagnoses, whatever the procedure implemented: Diagnostic interview vs. i) Another diagnostic interview, vs. ii) An expert diagnosis or vs. iii) Scales and questionnaires. Overall, the K-SADS-PL appeared to be the instrument that has the best test-retest reliability for Anxious Disorders and Affective Disorders (the value kappa showing good to excellent reliabilities). Several important methodological observations emerged from this review. Firstly, the metrological data corresponding to the diagnoses according to DSM IV or ICD-10 criteria's were lacking. The face validity was globally satisfactory, but the data concerning their face-to-face validities and their test-retest reliability, although better than in the former versions, were limited because they were tested on small sample. In fact, it appeared that the agreements depend on the informant, the sample studied, the various diagnostic categories and the instrument used. Since the studies carried out by Cohen et al., with now obsolete versions of the DISC and K-SADS, no other study establishing a comparison between two EDS have been conducted. Consequently, the clinicians must be very careful before comparing DSM or ICD diagnoses generated by different instruments. The second point was the length of the interviews that appeared sometimes longer than instruments used in adults, considering the fact that diagnostic procedure implies two independent interviews, one with the child/adolescent and one with the adult referent. The minimum duration was found to be 1 h 30 for the Chips in clinical setting, while it could reach 4 h or more for the DISC IV or the ISCA. The interviews had to be often carried out in several sessions, so the assessment became very difficult in easily tired and/or distractible subjects. The third point referred to the necessity to consider multiple data sources in young patients during the diagnostic procedure, and the weakness of the levels of agreement generally reported between sources. Empirically, it was observed that the investigator granted more weight to the report of the children than to the parent's one, when the clinical judgement was necessary to synthesize the data. On another level, studies showed a high agreement on the factual contents or on the specific events (ex: hospitalization), like on the obvious symptoms (ex: enuresis). The parents report more problems of behaviour, school and relational difficulties, whereas the children report more fear, anxiety, obsessions and compulsions, or delusional ideas. In other words, it appeared that children were better informants in describing their mental states (internalised disorders), and that adults would bring more reliable information in describing externalised disorders. Like McClellan and Werry, we think that further researches are needed to clarify if and when this is the case. The last major point concerned the problem of language. These instruments must be used in the maternal language of the interviewees and they were developed for most of them into English only. For example, there is only one instrument available into French (the Kiddie SADS). Nowadays, it remains difficult to conduct international studies in child and adolescent psychiatry and/or to compare data is this domain. To conclude, the use of the EDS and EDSS brings many benefits, in academic researches as well as in clinical practice, but a more systematic use is limited by a certain number of parameters. The instruments currently available in child and adolescent are far from being optimal in terms of quality and quantity. It seems necessary and useful to contribute to their development and their improvement. In particular, the following points should be considered: drastic reduction of the length of the interviews; simplification in the use of these instruments, during the interviews, but also in the treatment of the data collected during the final phase of diagnosis generation, the clinician having to carry out ceaseless returns to check the presence or not of each diagnostic criterion; reduction of the duration of the highly necessary training, which can be easily solved by the global simplification of the instruments; quantitative and qualitative improvements of psychometric properties, in particular in terms of sensitivity, specificity and face-to-face validity. Finally, it is highly necessary to continue to develop structured diagnostic interviews adapted to the assessment of child and adolescent psychiatric diagnoses keeping in mind simplicity, feasibility and reliability. Developing this kind of instruments is hard, expensive, and sometimes tiresome but it remains the inescapable stage to produce high quality data in the future.

A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample

This study examined the psychometric properties of the parent version of the Spence Children's Anxiety Scale (SCAS-P); 484 parents of anxiety disordered children and 261 parents in a normal control group participated in the study. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV (namely separation anxiety, generalized anxiety, social phobia, panic/agoraphobia, obsessive-compulsive disorder, and fear of physical injuries). A post-hoc model in which generalized anxiety functioned as the higher order factor for the other five factors described the data equally well. The reliability of the subscales was satisfactory to excellent. Evidence was found for both convergent and divergent validity: the measure correlated well with the parent report for internalizing symptoms, and lower with externalizing symptoms. Parent-child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group. The measure differentiated significantly between anxiety-disordered children versus controls, and also between the different anxiety disorders except GAD. The SCAS-P is recommended as a screening instrument for normal children and as a diagnostic instrument in clinical settings.

Life events and personality factors in children and adolescents with obsessive-compulsive disorder and other anxiety disorders

The association among life events, personality factors, and anxiety disorders in children and adolescents was assessed in 28 children with obsessive-compulsive disorder (OCD), 28 children with other anxiety disorders (AD), and 24 normal controls using the Life Events Checklist (LEC) and the Junior Temperament and Character Inventory (JTCI). No significant differences were found among the groups for demographic and clinical characteristics. Children with OCD had significantly more total life events and more negative life events in the year before onset than normal controls, and they perceived the life events as having more impact. Scores for children with other AD fell between the other two groups for most of the life event parameters. The only specific life event that distinguished children with AD from normal controls was major illness or injury of a relative. High anxiety levels and older age--but not depression level--predicted a greater perceived impact of life events. Children with OCD and other AD both scored higher than normal controls on the harm avoidance parameter of the JTCI. Harm avoidance scores correlated positively and significantly with the reported occurrence of negative life events and their perceived impact. Thus, quantity, quality, and specificity of life events may be associated with AD in young people, especially OCD. This association may be related to the personality characteristic of harm avoidance.

A questionnaire for screening a broad range of DSM-defined anxiety disorder symptoms in clinically referred children and adolescents

OBJECTIVE

To examine the reliability and validity of the 66-item Screen for Child Anxiety Related Emotional Disorders-Revised (SCARED-R), a questionnaire for measuring a broad range of DSM-defined anxiety disorder symptoms, in a sample of clinically referred youths.

METHOD

The SCARED-R was administered to children/adolescents and their parents during the standard intake assessment. SCARED-R scores were compared against Child Behavior Checklist (CBCL) scores, DSM-IV axis I classifications, and global assessment of functioning (GAF) ratings.

RESULTS

In this sample of clinically referred youths, the SCARED-R was reliable in terms of internal consistency and showed reasonable child-parent agreement. Furthermore, SCARED-R scores correlated significantly with CBCL internalising but not with externalising. Within the group of children with anxiety disorders, SCARED-R scores were also negatively associated with children's daily functioning as rated on the GAF scale. Finally, SCARED-R scores had satisfactory discriminant validity (both between anxiety disorders and other problems and within anxiety disorders), and appeared to have reasonable value for predicting specific anxiety disorders.

CONCLUSION

The SCARED-R is a valuable addition to the arsenal of questionnaires that are used for the assessment of anxiety in youths.

Psychometric properties of the Spence Children's Anxiety Scale with young adolescents

The psychometric properties of the Spence Children's Anxiety Scale (SCAS) were examined with 875 adolescents aged 13 and 14 years. This self-report measure was designed to evaluate symptoms relating to separation anxiety, social phobia, obsessive-compulsive disorder, panic-agoraphobia, generalized anxiety, and fears of physical injury. Results of confirmatory and exploratory factor analyses supported six factors consistent with the hypothesized subtypes of anxiety. There was support also for a model in which the first-order factors loaded significantly on a single second-order factor of anxiety in general. The internal consistency of the total score and sub-scales was high, and 12-week test-retest reliability was satisfactory. The SCAS correlated strongly with a frequently used child self-report measure of anxiety and significantly, albeit at a lower level, with a measure of depression.

A practical guide to using ratings of depression and anxiety in child psychiatric practice

The objective of this paper is to provide pragmatic information on commonly used rating scales of depression and anxiety disorders with established psychometric properties. A comprehensive Medline search on the rating scales of depression and anxiety was conducted. Relevant research findings were further synthesized where possible, with the information on clinical use of the scales from manuals. Research findings replicating original studies, strengths, weaknesses, and scoring information were summarized for each scale, and psychometric properties were tabulated. Several rating scales are available for screening, determining the severity, as well as estimating treatment effects in depression and anxiety. It is prudent to use more than two scales, especially a combination of self-rating scale and a clinician rating scale. It is recommended that the depression and anxiety scales are used in concert to aid in differentiating these two disorders. Several new and improved scales are available, although they await further replication.

Heart-beat perception, panic/somatic symptoms and anxiety sensitivity in children

There is considerable evidence implicating heart-beat perception (HBP) accuracy and anxiety sensitivity (AS) in the development of panic in adults. However, to date there have been no studies exploring the association between HBP, AS and childhood panic/somatic symptoms. Seventy-nine children aged 8 to 11 years completed a mental tracking paradigm (Psychophysiology 18 (1981) 483) to assess HBP, the Children's Anxiety Sensitivity Index (J Clin Chil Psychol 20 (1991) 162) and the Screen for Childhood Anxiety Related Emotional Disorders (J Am Acad Child Adoles Psych 38 (1999) 1230). Those with good HBP (n = 7, 9%) had significantly higher panic/somatic symptoms (t = -1.71, P < 0.05), and AS (t = -2.16, P < 0.02) than those with poor HBP. There were no effects of age, sex or BMI on HBP. Those with high levels of panic/somatic symptoms were seven times more likely to have good HBP and had AS scores 1 S.D. higher than the remainder of the sample. Multivariate analyses revealed that these two phenotypes had independent associations with high panic/somatic symptoms. These results extend the literature on HBP and panic and suggest that in children, as in adults, increased panic/somatic symptoms are associated with enhanced ability to perceive internal physiological cues, and fear of such sensations.

Cognitive-behavioral treatment for adolescents who sexually offend and their families: individual and family applications in a collaborative outpatient program

This article describes an outpatient treatment program for adolescent sexual abusers that was established by a mental health agency in collaboration with a specialized probation program in the juvenile court. Individualized treatment is based on a comprehensive clinical assessment with the youth and guardian, for which examples are provided. Given the heterogeneity of this population, we describe several treatment strategies directed to various individual or family clinical targets, including psychiatric disorders, sexual deviance and sexuality, normal adolescent development and adaptive skills, and parent and family relationships. Ongoing collaborative and coordination issues are also reviewed. The integration of mental health and probationary services provides a balanced approach to the community management and treatment of the low-risk, primarily first-time, adolescent sexual offender.

Diagnosis and measurement of anxiety disorder in adolescents: a review of commonly used instruments

As part of a comprehensive review of clinical research tools used in adolescent psychiatric disorders, a survey of 200 recent studies of adolescent anxiety (publication dates of December 1994 to May 2001) identified 70 different diagnostic and symptom measurement instruments. The design features and psychometric properties of the 15 most commonly used instruments were reviewed, and their strengths and weaknesses were evaluated. The conclusions arising from this review are: (1) too many different instruments are being used by investigators; (2) more than 20% of studies did not report the use of developmentally appropriate (i.e., child/adolescent-specific) diagnostic instruments; (3) another 15% of these studies relied on diagnostic instruments that demonstrate substantial weaknesses in reliability and validity; (4) the concordance between anxiety disorder diagnoses from different interview schedules is unknown; (5) the relative validity of diagnoses and ratings of anxiety severity based on information yielded by parents versus information yielded by adolescents is unclear; (6) clinician-rated symptom severity scales specific to anxiety disorder are rarely utilized; (7) the most commonly used self-report measures discriminate poorly between anxiety and depression, and their items are not indexed to specific anxiety disorders; and (8) some newer self-report anxiety instruments discriminate well between anxiety and depression and have diagnostic validity for specific anxiety disorders.

An open trial of fluoxetine for adolescents with bulimia nervosa

OBJECTIVE

This open clinical trial examined the feasibility, tolerability, and efficacy of treating adolescents who suffer from bulimia nervosa with fluoxetine.

METHODS

Ten adolescents, ages 12-18 years received 8 weeks of fluoxetine 60 mg/day with supportive psychotherapy. Primary outcome measures included frequencies of binge eating and purging and ratings on the Clinical Global Impressions-Improvement scale (CGI-I). Secondary outcome measures included self-report measures of eating disorder, depression, and anxiety symptoms. Safety and tolerability of this dose of fluoxetine were also assessed.

RESULTS

Average weekly binges decreased significantly from 4.1 +/- 3.8 to 0 (p < 0.01). Average weekly purges decreased significantly from 6.4 +/- 5.2 to 0.4 +/- 0.9 (p < 0.005). All patients improved on the CGI-I scale, with 20% rated as much improved, 50% improved, and 30% slightly improved. All subjects tolerated the 60-mg dose of fluoxetine, and there were no dropouts due to adverse effects from the medication.

DISCUSSION

Fluoxetine is generally well tolerated and may be an effective treatment option for adolescents with bulimia nervosa.

A psychometric evaluation of the parent report form of the State-Trait Anxiety Inventory for Children--Trait Version

We examined the psychometric characteristics of the State-Trait Anxiety Inventory for Children-Parent Report-Trait Version (STAIC-P-T) [Strauss, C. (1987). Modification of trait portion of State-Trait Anxiety Inventory for Children-Parent Form. Gainesville, FL: University of Florida], a brief, parent report paper-and-pencil measure of child chronic anxiety, in a large clinic-referred sample. Internal consistency coefficients were high and retest reliability coefficients were in the moderate range. Convergent validity evidence was mixed in its support for the measure, with evidence most supportive within reporter and within parental dyad. Divergent validity evidence provided less support for the measure, but was largely consistent with past research. Regression analyses indicated that parent reports on the STAIC-P-T were not significantly related to a parent's own level of symptomatology. Overall, the study provides mixed support for the psychometrics of the STAIC-P-T.

Screen for Child Anxiety Related Emotional Disorders (SCARED): psychometric properties in an African-American parochial high school sample

OBJECTIVE

To examine the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) for a community sample of African-American high school students.

METHOD

The 41-item SCARED was administered to 111 adolescents (57 girls; mean age 15.75) in an urban parochial school. Item frequency, internal consistency, test-retest reliability, and construct validity were assessed.

RESULTS

Approximately 30% of the sample had scores high enough to warrant further assessment for anxiety disorders, and girls reported significantly higher anxiety symptoms than boys. Internal consistency (alpha =.89) and test-retest reliability (r = 0.47) over 6 months for the SCARED's total score were good. The SCARED's total score was positively correlated with other measures of anxiety symptoms and inattention and was negatively correlated with perceived self-worth. Unlike the five-factor structure reported for primarily white samples, only three factors emerged for this African-American sample.

CONCLUSIONS

The SCARED shows utility as a self-report anxiety screening instrument in a community sample of African-American youths.

Parental opinions regarding treatment for social anxiety disorder in youth

This study surveyed parents' opinions about treatment for childhood social anxiety disorder and assessed variables that may affect treatment acceptability. A 20-item survey assessing treatment attitudes and a semistructured interview were administered to 190 parents of children (8-17 years) who were randomly selected from a pediatric primary care setting. An exploratory factor analysis of the treatment attitudes survey yielded four factors: medication acceptability, counseling acceptability, counseling feasibility, and general beliefs about social anxiety treatment. Findings revealed that parents endorsed favorable attitudes toward counseling and somewhat neutral beliefs about medication. White parents were more accepting of medication and counseling and also perceived counseling as more feasible than nonwhite parents. Treatment acceptance was associated with past mental health utilization but not with severity of social anxiety. Further research is necessary to determine if clinical interventions for child anxiety disorders may be more efficacious if parents' attitudes and beliefs about prescribed treatments are addressed.

Anxiety, Somatic Complaints, and Depressive Symptoms in Rural Adolescents

PROBLEM

Undiagnosed and untreated anxiety in adolescents is often associated with greater rates of mood and behavior problems, somatic complaints, and risk for future psychiatric disorders. METHODS. A self-report anxiety instrument was administered as part of a community survey of 466 rural adolescents.

FINDINGS

Anxiety symptoms were strongly correlated with both physical complaints and depression. Females had higher scores for total anxiety and the anxiety subtypes of generalized anxiety disorder, separation anxiety disorder, panic disorder, social phobia, and school phobia.

CONCLUSIONS

Implications for nursing practice are provided.

Primary care clinicians' use of standardized tools to assess child psychosocial problems

BACKGROUND AND OBJECTIVES

Children's psychosocial problems are prevalent but often inaccurately diagnosed. This study investigated primary care clinicians' (PCCs) use of standardized tools for psychosocial problems among children in whom they reported finding a problem.

METHODS

The data consisted of 21 065 unique visits by children ages 4 to 15 years in 204 practices. Parents completed questionnaires before seeing the PCCs, who completed a survey after the visit. This analysis included 3934 children who were recognized by PCCs as having one or more psychosocial problems. The primary outcome was the PCCs' usage of a tool to assess child psychosocial problems.

RESULTS

PCCs used a tool in 20.2% of visits where a psychosocial problem was recognized, whereas 50% of PCCs never used such tools. Tools were less likely to be used by female PCCs and family practitioners and were less likely to be used with girls and African American children. Tools were more frequently used with children with attention problems, during visits for psychosocial problems, and when the PCC knew about the problem before the visits.

CONCLUSIONS

PCCs use standardized tools infrequently to screen for, confirm, or monitor psychosocial problems.

An immunological marker (D8/17) associated with rheumatic fever as a predictor of childhood psychiatric disorders in a community sample

BACKGROUND

Previous studies have documented that various behavioral disturbances accompany Sydenham's chorea, a neurologic variant of rheumatic fever. Further, an immunological marker associated with rheumatic fever (monoclonal antibody D8/17) has been reported to be elevated in several neuropsychiatric disorders, most frequently tics and obsessive-compulsive disorder. We examined this association in a community sample of children previously identified as being D8/17 positive or negative. It was hypothesized that D8/17 positivity would predict increased rates of tics and obsessive-compulsive disorder, even in the absence of Sydenham's chorea. Possible associations with other disorders accompanying Sydenham's chorea--hyperactivity, anxiety, and depression, also were explored.

METHOD

From 1991 to 1995, 2631 children (mean age = 9.6 +/- 1.6 years) from a low socioeconomic area of Mexico City were screened for the D8/17 marker. In a 2- to 5-year follow-up of 240 of these children (108 positive and 132 negative), structured psychiatric interviews and rating scales were administered to the child and main caretaker. Assessments were conducted and scored blind to the child's D8/17 status.

RESULTS

No association was seen between D8/17 positivity and tics or OCD.

CONCLUSION

This study failed to provide support for the generalized use of D8/17 as a marker of susceptibility to tics and OCD in a community sample.

Posttraumatic stress disorder in children: diagnosis, assessment, and associated features

Although a growing body of research has increased knowledge of the after-effects of trauma in children, including the development of PTSD, there are significant gaps in this knowledge concerning diagnosis, assessment, and associated features. With regard to diagnosis, variations in symptomatic expression of PTSD in children have been proposed; however, there have been few examinations of the validity of these variations in terms of course and consequence of PTSD defined in these ways. Several factors increase children's risk for development of PTSD or PTSD symptoms after trauma. Such information is potentially useful for identifying children who may benefit from more thorough or ongoing assessment after trauma. With regard to assessment, an array of increasingly sophisticated and clinically useful measures is being developed; however, currently there is a dearth of high quality data concerning the diagnostic use of different assessments. An area of general weakness concerning these assessments is the limited data on discriminant validity. A sizeable body of evidence indicates that trauma can produce diverse reactions in children, including a general increase in internalizing and externalizing symptoms. Clinically useful measures allow PTSD to be differentiated from this general reaction to traumatic events, much of which may reflect a nonpathologic response. With regard to associated features, limited information suggests that PTSD can have a cascading negative effect on children's development and functioning. More research is needed, however, to delineate factors that reflect risk for PTSD after trauma, factors that reflect consequences of PTSD, and mediating variables.

A self-report questionnaire for measuring separation anxiety in adulthood

Little attention has been given to measuring symptoms of separation anxiety (SA) in adulthood. The development of an Adult Separation Anxiety Questionnaire (ASA-27) is described and compared to a previously derived Adult Separation Anxiety Semistructured Interview (ASA-SI). Principal components analysis revealed a coherent construct of SA with high internal consistency (Cronbach's alpha =.95) and sound test-retest reliability (r =.86; P <.001). A receiver operation characteristic (ROC) analysis against the semistructured interview yielded a high area under the curve index (AUC = 0.9) suggesting that the questionnaire is an adequate alternative measure of SA. Results of this study support previous research suggesting that a construct of SA may be readily measured in adults.

Anxiety sensitivity and panic attack symptomatology among low-income African-American adolescents

This study examined the concurrent and prospective relation between anxiety sensitivity (AS) and panic attack symptomatology among a community sample of African-American adolescents (N = 107; mean age 15.6 years) from predominantly low-income, single-parent households. On two occasions, 6 months apart, youth completed self-report measures of AS, measured by the Childhood Anxiety Sensitivity Index (CAS I), and panic symptomatology, measured by the Panic Attack Questionnaire (PAQ) and/or the Panic subscale of the Screen for Child Anxiety-Related Emotional Disorders (SCARED-P). Results indicated that adolescents with high levels of AS reported higher concurrent levels of panic symptomatology, compared to their less anxious peers. Earlier levels of AS were correlated with panic symptoms 6 months later but did not predict later panic symptoms once initial levels of panic were controlled. Panickers, compared to non-panickers, also reported significantly higher levels of AS at Time 2. Overall, these findings are consistent with research on AS and panic in adult and Caucasian populations and support the hypothesis that elevated levels of AS may be one of several risk factors implicated in the development of panic attack symptomatology.

Treatment of pediatric anxiety disorders: an open-label extension of the research units on pediatric psychopharmacology anxiety study

BACKGROUND

An 8-week placebo-controlled study, the Research Units on Pediatric Psychopharmacology Anxiety Study, documented beneficial effects of fluvoxamine in the treatment of pediatric social anxiety, separation anxiety, or generalized anxiety disorders. Following completion of this study, participants were invited to enter a 6-month open-label treatment phase designed to examine three issues: (a) long-term maintenance of response in fluvoxamine responders, (b) acute response to fluoxetine in fluvoxamine nonresponders, and (c) acute response to fluvoxamine in placebo nonresponders.

METHODS

Participants aged 6-17 years meeting criteria for social anxiety, separation anxiety, or generalized anxiety disorders previously treated in an 8-week placebo-controlled trial (n = 128) were offered open treatment. Changes in symptoms of anxiety during open treatment were assessed in three groups: (a) fluvoxamine responders maintained on fluvoxamine, (b) fluvoxamine nonresponders changed to fluoxetine, and (c) placebo nonresponders changed to fluvoxamine. Response was defined based on Clinical Global Impression criteria.

RESULTS

During 6 months of continued open treatment, anxiety symptoms remained low in 33 of 35 (94%) subjects who initially responded to fluvoxamine. Among 14 fluvoxamine nonresponders switched to fluoxetine, anxiety symptoms appeared significantly improved in 10 (71%) subjects. Finally, among 48 placebo nonresponders, 27 (56%) showed clinically significant improvement in anxiety on fluvoxamine.

CONCLUSION

The current findings concerning extended treatment of pediatric anxiety disorders are only preliminary, because treatment was uncontrolled. Results suggest that an initial fluvoxamine response is likely to be retained with continued treatment, that some fluvoxamine nonresponders may respond to fluoxetine, and that some placebo nonresponders may respond to fluvoxamine.

The links between the Adolescent Dissociative Experiences Scale (A-DES), fantasy proneness, and anxiety symptoms

The purpose of this study was to further examine the psychometric properties of the Adolescent Dissociative Experiences Scale (A-DES). A sample of normal adolescents (N = 331) aged 12 to 18 years completed the A-DES and questionnaires measuring posttraumatic stress disorder (PTSD) symptoms, other anxiety disorder symptoms, and fantasy proneness. Factor analysis indicated that the A-DES, at least in nonreferred youths, is assessing a single dimension of dissociation. Furthermore, A-DES scores are not only significantly related to PTSD symptoms but also to other anxiety disorder symptoms (i.e., generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder) and fantasy proneness. Theoretical and practical implications of these findings are briefly discussed.

Sexually Abused Children Suffering From Post-traumatic Stress Disorder: Assessment and Treatment Strategies

Child sexual abuse is a highly prevalent problem that frequently occasions the onset of post-traumatic stress disorder in the victimized youngster. This selective review addresses recent advances in the assessment and treatment of sexually abused children with post-traumatic stress disorder. Firstly, we outline the diagnostic criteria for post-traumatic stress disorder and significant moderating variables in the development of post-traumatic stress disorder. Secondly, we address the clinical assessment of post-traumatic stress disorder in sexually abused children, recommending a developmentally sensitive, multi-informant approach. Thirdly, we consider a family-wide cognitive-behavioural treatment framework for sexually abused children with post-traumatic stress disorder that involves both child and non-offending caregivers. Fourthly, we examine the results of recent evaluation studies supportive of cognitive-behavioural therapy in the treatment of sexually abused children. Lastly, we consider conclusions for clinical practice and directions for future research.

Psychological comorbidity and stress reactivity in children and adolescents with recurrent abdominal pain and anxiety disorders

OBJECTIVE

To compare clinical symptoms, diagnoses, and physiological measures in children and adolescents with recurrent abdominal pain (RAP) (n = 14), to a group with anxiety disorders (ANX) (n = 14) and a physically and psychiatrically healthy control group (HC) (n = 14).

METHOD

The cross-sectional study examined group differences in clinical symptoms of anxiety, somatic complaints, depression, and behavior problems. Physiological measures included heart rate, systolic and diastolic blood pressure, and salivary cortisol in response to the Trier Social Stress Test for Children (TSST-C). Subjects were between the ages of 8 and 16 years.

RESULTS

RAP and ANX subjects had comparable scores on most psychological measures, and their scores were higher (n < .05) than those of the HC. The ANX and RAP groups exhibited physiological findings that had more shared similarities than either group with the HC group. Few statistically significant group differences were noted in physiological measures, yet the pattern of findings in blood pressure and cortisol supported the use of the TSST-C and the direction of the findings was consistent with expectations.

CONCLUSIONS

Understanding more about comorbidity between RAP and anxiety could have important management implications, with observed congruities between the disorders suggesting treatments already demonstrated to be efficacious for pediatric anxiety and depression might be applied productively to RAP.

DSM-IV-defined anxiety disorder symptoms in South African children

OBJECTIVE

To examine -defined anxiety disorder symptoms in a large sample of normal South African schoolchildren.

METHOD

Children completed two self-report questionnaires: the Spence Children's Anxiety Scale (SCAS) and the 41-item version of the Screen for Child Anxiety Related Emotional Disorders (SCARED).

RESULTS

Psychometric properties of the SCAS and the SCARED were moderate (convergent validity) to sufficient (reliability). Factor analyses yielded evidence for the presence of a number of hypothesized anxiety categories (i.e., social phobia, panic disorder, fears, and generalized anxiety disorder). Furthermore, anxiety levels of South African children were higher than those of Western (i.e., Dutch) children. Differences were found with regard to the content of prevalent anxiety symptoms among South African and Western children.

CONCLUSION

Although psychometric properties of the SCAS and the SCARED in South African children somewhat deviated from those obtained in Western countries, both scales seem to be useful for assessing childhood anxiety symptoms in this country.

Development and validation of a measure of children's automatic thoughts: the children's automatic thoughts scale

The aim of this study was to describe the history, factor structure and psychometric properties of the Children's Automatic Thoughts Scale (CATS). The CATS is a self-report measure designed to assess a wide range of negative self-statements in children and adolescents. The results of confirmatory factor analyses supported four distinct but strongly correlated factors relating to automatic thoughts on physical threat, social threat, personal failure and hostility. The internal consistency of the total score and subscales was high and test-retest reliability at 1 and 3 months was acceptable. The CATS effectively discriminated between control children and adolescents, and clinically anxious, depressed, or behavior disorder children and adolescents, and showed good discriminant validity across clinical subgroups on the subscales. Results suggest that the CATS is a promising instrument in the assessment of a range of negative automatic thoughts across both internalizing and externalizing problems in young people.

Decreased chaos of heart rate time series in children of patients with panic disorder

This study examined the differences of heart rate variability measures between children of parents with panic disorder and children of healthy controls using linear as well as nonlinear techniques. Supine and standing heart rate variability indices were measured in all children using power spectral analysis and a measure of chaos, the largest Lyapunov exponent (LLE) of heart rate time series. No significant differences emerged between the children of panic disorder parents and children of normal controls on any of the spectral heart rate variability measures. However, children of patients with panic disorder had significantly lower LLE of heart rate time series in supine posture, suggesting a relative decrease of cardiac vagal function in this group of children. This suggests a possible heritable effect of certain measures of heart rate variability, as previous studies showed decreased heart rate variability in patients with panic disorder using spectral as well as nonlinear techniques. Recent evidence also suggests that some of these nonlinear measures are superior or of additional value to the traditional time and frequency domain measures of heart rate variability to predict serious ventricular arrhythmias and sudden death.

The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties

OBJECTIVE

To describe the development and psychometric properties of the Pediatric Anxiety Rating Scale (PARS), a clinician-rated instrument for assessing the severity of anxiety symptoms associated with common DSM-IV anxiety disorders (social phobia, separation anxiety disorder, and generalized anxiety disorder) in children.

METHOD

As part of a multisite study of the efficacy of fluvoxamine, 128 children (aged 6-17) and their parents were interviewed weekly with the PARS. Data from multiple raters on a subsample of children (using live and videotaped interviews) were used to evaluate interrater reliability. Internal consistency, test-retest reliability, and validity (convergent, divergent) also were evaluated.

RESULTS

The PARS showed high interrater reliability, adequate test-retest reliability, and fair internal consistency. Convergent and divergent validity were satisfactory. PARS scores were sensitive to treatment and paralleled change in other measures of anxiety symptoms and global improvement.

CONCLUSIONS

The PARS is a useful clinician-rated instrument for assessing pediatric anxiety symptoms, severity, and impairment, particularly in treatment studies. Further study of the psychometric properties is warranted.

Three traditional and three new childhood anxiety questionnaires: their reliability and validity in a normal adolescent sample

The current study examined the psychometrics of three traditional [i.e., the trait anxiety version of the State-Trait Anxiety Inventory for Children (STAIC), the Revised Children's Manifest Anxiety Scale (RCMAS), and the Fear Survey Schedule for Children - Revised (FSSC-R)] and three new childhood anxiety scales [the Multidimensional Anxiety Scale for Children (MASC), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Spence Children's Anxiety Scale (SCAS)] in a large sample of normal adolescents (N=521). Childhood anxiety scales were generally found to be reliable in terms of internal consistency. Furthermore, evidence was obtained for the convergent and divergent validity of the various anxiety questionnaires. That is, anxiety questionnaire scores were found to be substantially intercorrelated. Particularly strong associations were found between total scores of the STAIC and the RCMAS, total scores of the SCARED and the SCAS, and between subscales that intend to measure specific categories of anxiety symptoms. Childhood anxiety questionnaires were substantially connected to an index of depression, although correlations among anxiety questionnaires were generally higher than those between anxiety scales and a measure of depression.

School-based treatment for anxious african-american adolescents: a controlled pilot study

OBJECTIVE

To evaluate the feasibility and effectiveness of a school-based group cognitive-behavioral treatment (CBT) for anxiety disorders with African-American adolescents.

METHOD

Twelve adolescents (mean age = 15.6 years) with anxiety disorders were randomly assigned to CBT (n = 6) or a group attention-support control condition (AS-Control; n = 6). Both groups met for 10 sessions in the same high school. Key treatment ingredients in CBT involved exposure, relaxation, social skills, and cognitive restructuring. Key ingredients in AS-Control involved therapist and peer support. At pre- and posttreatment, diagnostic interviews were conducted, and adolescents completed self-report measures of anxiety.

RESULTS

At posttreatment and among those who attended more than one treatment session, 3/4 adolescents in CBT no longer met diagnostic criteria for their primary anxiety disorder, compared with 1/5 in AS-Control. Clinician ratings of impairment and self-report levels of overall anxiety were significantly lower at posttreatment in CBT compared with AS-Control. Teenagers in both groups reported lower levels of social anxiety from pre- to posttreatment.

CONCLUSIONS

Findings support the feasibility of implementing a manual-based CBT in an urban school setting. Responder rates among African-American adolescents were similar to those found in studies with white youths.

Ten-year review of rating scales. II: Scales for internalizing disorders

OBJECTIVE

This article, the second in the Journal's series of 10-year updates on rating scales, summarizes scales assessing internalizing disorders.

METHOD

The authors sampled articles on mood and anxiety disorders over the past 25 years, selected scales with multiple citations over many years, and reviewed their properties. Those with adequate psychometric properties, plus continued wide literature citations or a current special niche, are presented here.

RESULTS

Rating scales for depression were developed and/or examined in the 1980s. Despite generally strong properties, they lack clear construct validity. Most have parent-report forms that broaden their suitability with youths. Anxiety scales were developed bimodally. Those developed in the 1960s to 1970s were downward modifications of adult scales. They have been criticized for unclear constructs and unsuitability for youths. Newer scales developed in the 1990s have addressed these problems and have parent-report forms. However, their utility is still being determined.

CONCLUSIONS

Rating scales can reliably, validly, and efficiently measure youths' internalizing psychopathology. They have great utility in research, treatment planning, and accountability in practice. However, the user must define the goals of measurement, consider the construct the scale measures, and use the scale within its defined capabilities. The use of more than one scale for a task is recommended.

Superior temporal gyrus volumes in pediatric generalized anxiety disorder

BACKGROUND

The essential symptoms of generalized anxiety disorder (GAD) are intrusive worry about everyday life circumstances and social competence, and associated autonomic hyperarousal. The amygdala, a brain region involved in fear and fear-related behaviors in animals, and its projections to the superior temporal gyrus (STG), thalamus, and to the prefrontal cortex are thought to comprise the neural basis of our abilities to interpret social behaviors. Larger amygdala volumes were previously reported in pediatric GAD; however, the brain regions involved in social intelligence were not examined in this pilot study.

METHODS

Magnetic resonance imaging (MRI) was used to measure the STG, thalamus, and prefrontal volumes in 13 medically healthy child and adolescent subjects with generalized anxiety disorder (GAD) and 98 comparison subjects, who were at low familial risk for mood and psychotic disorders. Groups were similar in age, gender, height, weight, handedness, socioeconomic status, and full-scale IQ.

RESULTS

The total, white matter, and gray matter STG volumes were significantly larger in GAD subjects compared with control subjects. Thalamus and prefrontal lobe volumes did not differ between groups. Findings of significant side-by-diagnosis interactions for STG and STG white matter volumes suggest that there is a more pronounced right > left asymmetry in total and STG white matter volumes in pediatric GAD subjects compared with control subjects. A significant correlation between the STG white matter percent asymmetry index with the child report of the Screen for Child Anxiety Related Emotional Disorders Scale was seen.

CONCLUSIONS

These data agree with previous work implicating posterior right-hemispheric regions in anxiety disorders and may suggest developmental alterations in pediatric GAD.

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

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.

Links between community violence and the family system: evidence from children's feelings of relatedness and perceptions of parent behavior

In this study, we examined some of the ways in which broader ecological systems may influence the organization of behavior within the family system. Specifically, links between exposure to community violence and children's relationships with maternal caregivers were investigated in a sample of 127 urban children between the ages of 7 and 13 years. Children were asked to indicate whether they had been exposed to a wide variety of violent events. In addition, their feelings of relatedness and separation anxiety, and their perceptions of maternal behavior were assessed. It was expected that exposure to community violence would be associated with feeling less secure with caregivers. Consistent with predictions from ecological-transactional theory, data supported this hypothesis. Children who reported that they had been exposed to high levels of community violence also indicated that they felt less positive affect when with their caregiver, were dissatisfied with how close they felt to her, felt more separation anxiety, and reported more negative maternal behavior than children exposed to less violence. Findings are discussed in terms of how violence may affect the family system and the protective function of human attachment.

An analysis of the RCMAS Lie scale in a clinic sample of anxious children

Examined Revised Children's Manifest Anxiety Scale (RCMAS) Lie scores in a sample of 284 anxious children. Lie scores were examined in relation to children's age, ethnicity/race, and gender, and in relation to Total Anxiety scores. The utility of Lie scores also was examined in terms of whether they were predictive of children's anxiety levels as rated by children themselves, parents, and clinicians. Between-group differences in children's Lie scores were examined as well. Results indicated that younger children had significantly higher Lie scores than older children, and Hispanic American children had significantly higher Lie scores than European American children. There were no significant gender differences in Lie scores, and no significant relation was found between RCMAS Lie scores and Total Anxiety scores for the total sample. Subgroup analyses indicated that Lie scores were predictive of children's anxiety levels. Results also indicated that Lie scores were significantly different between children who presented with anxiety disorders and children who presented with anxiety and externalizing disorders. Findings are discussed in terms of the usefulness of RCMAS Lie scores.

Screen for Child Anxiety-Related Emotional Disorders (SCARED): convergent and divergent validity

The purpose of this study was to examine the Screen for Child Anxiety-Related Emotional Disorders' (SCARED) divergent and convergent validity and its ability to identify anxious children. The SCARED, the Child Behaviour Checklist (CBCL), and the State-Trait Anxiety Inventory for Children (STAIC) were administered to children, adolescents (n = 295), and their parents attending an outpatient mood and anxiety disorders clinic. DSM-IIIR/IV diagnoses were made using a semistructured interview (n = 130) or a symptom checklist (n = 165). The Multi-Trait Multi-Method Matrix was used to assess construct validity, and Receiver Operating Curve analysis was used to assess the sensitivity and specificity of the SCARED, CBCL, and STAIC. The SCARED correlated significantly better with the CBCL's internalizing factors than with the externalizing factors. In addition, 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), thus demonstrating the discriminant validity of the SCARED. The SCARED is a reliable and valid screening tool for clinically referred children and adolescents with anxiety disorders.

The structure of negative emotions in adolescents

This study examined the structure of negative emotions in a sample of nonclinical adolescents, using an approach that exclusively relied on child self-report. A large sample of adolescents (N = 968) completed self-report questionnaires measuring symptoms of fear, anxiety, and depression. Confirmatory factor analysis provided support for the notion that fear, anxiety, and depression are distinct yet correlated components of negative emotions. This result is in agreement with recent empirical findings and current theoretical notions on the structure of negative emotions in children and should be taken as an encouragement for researchers to develop more specific measures for assessing fear, anxiety, and depression in children.

Reliability, validity, and normative data of the Penn State Worry Questionnaire in 8-12-yr-old children

The Penn State Worry Questionnaire for Children (PSWQ-C) is a 14-item self-report questionnaire that intends to measure the tendency of children to engage in excessive, generalized, and uncontrollable worry (Chorpita et al., Behav. Res. Ther. 35 (1997) 569-581). The current study further examined the reliability and validity of the PSWQ-C in a large sample of 8-12-yr-old children (N = 486). Psychometric evaluation indicates that it is preferable to discard the three reverse scored items from the PSWQ-C when using the measure in this particular age group. The shortened 11-item PSWQ-C turned out to be reliable in terms of internal consistency and correlated meaningful with a scale measuring anxiety disorders symptoms. That is, PSWQ-C scores were significantly associated with all types of anxiety disorders symptoms but in particular with symptoms of generalized anxiety disorder. Normative data of the PSWQ-C are provided against which scores of individual children in this age range can be compared.

Fluvoxamine for the treatment of anxiety disorders in children and adolescents. The Research Unit on Pediatric Psychopharmacology Anxiety Study Group

BACKGROUND

Drugs that selectively inhibit serotonin reuptake are effective treatments for adults with mood and anxiety disorders, but limited data are available on the safety and efficacy of serotonin-reuptake inhibitors in children with anxiety disorders.

METHODS

We studied 128 children who were 6 to 17 years of age; who met the criteria for social phobia, separation anxiety disorder, or generalized anxiety disorder; and who had received psychological treatment for three weeks without improvement. The children were randomly assigned to receive fluvoxamine (at a maximum of 300 mg per day) or placebo for eight weeks and were evaluated with rating scales designed to assess the degree of anxiety and impairment.

RESULTS

Children in the fluvoxamine group had a mean (+/-SD) decrease of 9.7+/-6.9 points in symptoms of anxiety on the Pediatric Anxiety Rating Scale (range of possible scores, 0 to 25, with higher scores indicating greater anxiety), as compared with a decrease of 3.1+/-4.8 points among children in the placebo group (P<0.001). On the Clinical Global Impressions-Improvement scale, 48 of 63 children in the fluvoxamine group (76 percent) responded to the treatment, as indicated by a score of less than 4, as compared with 19 of 65 children in the placebo group (29 percent, P<0.001). Five children in the fluvoxamine group (8 percent) discontinued treatment because of adverse events, as compared with one child in the placebo group (2 percent).

CONCLUSIONS

Fluvoxamine is an effective treatment for children and adolescents with social phobia, separation anxiety disorder, or generalized anxiety disorder.

The DISC Predictive Scales (DPS): efficiently screening for diagnoses

OBJECTIVE

To derive and test a series of brief diagnosis-specific scales to identify subjects who are at high probability of meeting diagnostic criteria and those who may safely be spared more extensive diagnostic inquiry.

METHOD

Secondary data analysis of a large epidemiological data set (n = 1,286) produced a series of gate and contingent items for each diagnosis. Findings were replicated in a second retrospective analysis from a residential care sample (n = 884). The DISC Predictive Scales (DPS) were then used prospectively as a self-report questionnaire in two studies, in which parents (n = 128) and/or adolescents (n = 208) had subsequent diagnostic interviewing with the Diagnostic Interview Schedule for Children or the Schedule for Affective Disorders and Schizophrenia for School-Age Children.

RESULTS

All analyses showed that gate item selection was valid and that any missed cases were due solely to inconsistent reports on the same questions. Screening performance of the full scales was shown to be good, and substantial reductions in scale length were not associated with significant changes in discriminatory power.

CONCLUSIONS

The DPS can accurately determine subjects who can safely be spared further diagnostic inquiry in any diagnostic area. This has the potential to speed up structured diagnostic interviewing considerably. The full DPS can be used to screen accurately for cases of specific DSM-III-R disorders.

Generalized anxiety disorder in children and adolescents

Children and adolescents with GAD suffer from excessive, pervasive worries that interfere with social, academic, and family functioning. The comorbidity rate with other anxiety disorders and major depression is high. The course tends to be chronic, and evidence shows continuity between anxiety disorders in youth and adulthood. Individual and group CBT and the incorporation of family anxiety management training have demonstrated efficacy in the treatment of childhood GAD. No double-blind, placebo-controlled, pharmacotherapy trials with adequate sample sizes for children and adolescents with GAD have been published. Preliminary data support the potential efficacy of selective serotonin reuptake inhibitors, buspirone, and high-potency benzodiazepines. Adequately powered, controlled, pharmacologic treatment trials are necessary. Future research should be directed toward comparing the relative efficacy of psychotherapy, pharmacotherapy, and both in the treatment of GAD in youth.

School refusal in children and adolescents: a review of the past 10 years

OBJECTIVE

To critically review the past 10 years of research on school refusal in children and adolescents.

METHOD

Literature on school refusal published from 1990 onward was reviewed following a systematic search of PsycINFO. The review focuses on definitional issues, epidemiology and school refusal identification, diagnostic considerations, family functioning, assessment, treatment, and follow-up studies.

RESULTS

While definitional and conceptual issues are still evident, promising developments have occurred in relation to assessment and treatment practices and understanding of the family context of school refusal.

CONCLUSIONS

From a clinical viewpoint, school refusal cases require comprehensive assessment and treatment. Advances have been made in the treatment of school refusal. However, additional controlled studies evaluating interventions for school refusal are needed.

Childhood anxiety disorders: lessons from the literature

Studies of childhood anxiety disorders have increased in recent years, but the clinical implications of the work are sometimes difficult to discern. This paper reviews salient findings (related to the assessment and management of anxious children) published in the last 5 years. The high comorbidity among disorders, the occurrence of different disorders in the same child over time, recent changes in diagnostic categories, the availability of new anxiety measures, and poor correspondence between parent and child reports of symptoms all underscore the need for thorough assessment. Increasing evidence supports cognitive-behavioural treatments for anxiety disorders, alone or in combination with pharmacotherapy. Other important aspects of management suggested by developmental studies of anxious children include psychoeducation about constitutional factors in the development of anxiety, interventions to address parental anxiety, parenting advice regarding behaviour management and reduction of family conflict, and treatment of child impairment to decrease the risk of depression. Questions requiring further research are identified.

Screening for trauma in children and adolescents: the validity of the Traumatic Stress Disorder Scale of the screen for child anxiety related emotional disorders

Examined the validity of the Traumatic Stress Disorder scale of the Screen for Child Anxiety Related Emotional Disorders (SCARED), a recently developed self-report questionnaire measuring Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) defined anxiety disorders symptoms in children. A large sample of normal schoolchildren (N = 996) ages 7 to 19 years completed the SCARED. Children who scored high on the SCARED Traumatic Stress Disorder scale (i.e., trauma group; n = 43) and children who scored low on this scale (i.e., control group; n = 43) were then interviewed about their most aversive life event. In addition, children completed self-report questionnaires of traumatic experiences and posttraumatic stress disorder (PTSD) symptomatology. Results showed that children in the trauma group more frequently reported life events that independent judges considered to be 'potentially traumatic' than did control children. Furthermore, children in the trauma group reported having experienced more traumatic incidents and had higher scores on PTSD-related questionnaires compared with control children. Moreover, trauma group children more frequently fulfilled DSM-IV criteria for PTSD than did control children. The results of this study support the validity of the Traumatic Stress Disorder scale of the SCARED.