Psychometric properties of the Brazilian-Portuguese version of the Spence Children's Anxiety Scale (SCAS): self- and parent-report versions

Exploring the relationship between asthma, its severity and anxiety symptoms in pediatric patients: a case-control study

BACKGROUND

Asthma is a global health concern, especially among children, and is associated with various underlying mechanisms. Childhood exposure to early life stress and anxiety can potentially exacerbate asthma symptoms and complicate its management. While some studies have suggested the benefits of psychological therapies as adjuncts to medication in asthma management, evidence remains inconsistent, emphasizing the need for rigorous evaluation.

METHOD

This case-control study involved 120 children aged 5-15, with 60 children having asthma and 60 healthy controls. Asthma severity was assessed based on EPR3 guidelines, while anxiety symptoms were measured using the Spence Children's Anxiety Scale (SCAS). Demographic data and asthma-related information were collected via questionnaires. Statistical analyses were conducted to explore the relationship between asthma and anxiety.

RESULTS

Children with asthma exhibited significantly higher anxiety symptoms compared to those without asthma (p < 0.001). Subdomain analysis revealed elevated scores in separation anxiety (SA; p = 0.025), social phobia (SP; p < 0.001), agoraphobia (p = 0.004), and fears of physical injury (p < 0.001) in children with asthma. Furthermore, increased need for SABA, frequency of nocturnal symptoms, and asthma severity were associated with higher anxiety levels in pediatric asthma patients.

CONCLUSIONS

This study highlights a significant association between asthma and heightened anxiety symptoms in children, particularly in domains, such as SA, SP, agoraphobia, and fears related to physical injury. However, limitations include reliance on self-evaluation questionnaires and the observational nature of the study, emphasizing the need for cautious interpretation.

Exploring the role of immune pathways in the risk and development of depression in adolescence: Research protocol of the IDEA-FLAME study

Extensive research suggests a role for the innate immune system in the pathogenesis of depression, but most of the studies are conducted in adult populations, in high-income countries and mainly focus on the study of inflammatory proteins alone, which provides only a limited understanding of the immune pathways involved in the development of depression. The IDEA-FLAME study aims to identify immune phenotypes underlying increased risk of developing depression in adolescence in a middle-income country. To this end, we will perform deep-immunophenotyping of peripheral blood mononuclear cells and RNA genome-wide gene expression analyses in a longitudinal cohort of Brazilian adolescents stratified for depression risk. The project will involve the 3-year follow-up of an already recruited cohort of 150 Brazilian adolescents selected for risk/presence of depression on the basis of a composite risk score we developed using sociodemographic characteristics (50 adolescents with low-risk and 50 with high-risk of developing depression, and 50 adolescents with a current major depressive disorder). We will 1) test whether the risk group classification at baseline is associated with differences in immune cell frequency, phenotype and functional status, 2) test whether baseline immune markers (cytokines and immune cell markers) are associated with severity of depression at 3-year follow-up, and 3) identify changes in gene expression of immune pathways over the 3-year follow-up in adolescents with increased risk and presence of depression. Because of the exploratory nature of the study, the findings would need to be replicated in a separate and larger sample. Ultimately, this research will contribute to elucidating key immune therapeutic targets and inform the development of interventions to prevent onset of depression among adolescents.

Cross-cultural adaptation of an anxiety measure in a disadvantaged South African community context: Methodological processes and findings

An important challenge to enhancing community access to mental health interventions in marginalised, transcultural settings is the development of culturally relevant screening measures. Cross-cultural adaptation (CCA) and translation methods offer guidelines for the adaption of existing screening measures for use across cultures with the aim of preserving semantic and construct equivalence as well as validity. Yet, the application of CCA methods has been inconsistent and validation strategies have focused predominantly on expert review and quantitative validity testing. Additionally, potentially important context-specific interpretations of measure items have been lost in translation-heavy approaches. The missing link in the CCA of existing measures may be the addition of culturally sensitive, community-based evaluative methods. This paper presents a report of the application of a seven-step CCA method developed by the first author to address the issue of cultural relevance in the translation and cross-cultural adaptation of the Spence Child Anxiety Scale (SCAS) an anxiety measure for use in a specific South African community context. The findings emphasise the surprising context-specific interpretations of items in measures applied transculturally, which support the case for qualitative, community-based validation of translated, CCA screening measures used to explore the effectiveness of mental health interventions across cultural contexts.

Relationship between anxiety symptoms, clinical control and quality of life of children with asthma: A cross-sectional study

OBJECTIVE

To investigate the relationship between anxiety symptoms and factors related to clinical control and quality of life of children with asthma aged 7-12 years.

METHODS

A cross-sectional comparative study involving children recruited from a reference center for asthma treatment in the city of Natal-RN. Diagnosis, control and severity were performed following GINA recommendations (2019). Sociodemographic information and spirometry results from a bronchodilator test were collected. Modified Fisher's scale, clinical control questionnaires (c-ACT and ACT), quality of life assessment (PAQLQ) (total score and domains) and anxiety symptoms assessment (SCAS) (total score and domains) were applied.

RESULTS

The sample consisted of 42 children with asthma. Symptoms of social phobia (as identified by SCAS), and household head education were related to clinical asthma control (p = .006; R ²  = .19). Total SCAS score, guardian's education and physical activity were related to total PAQLQ (p < .0001; R ²  = .33). SCAS was related to the activity limitation domain of PAQLQ (p = .004; R ²  = .17). SCAS, gender, and physical activity were related to the PAQLQ symptoms domain (p = .003; R ²  = .32). The guardian's education, physical activity practice, and the symptoms of separation anxiety, panic attack and agoraphobia (as identified by SCAS) were related to the emotional domain of PAQLQ (p = .004; R ²  = .45).

CONCLUSION

The present study shows evidence of an association between anxiety symptoms, poorer clinical control, and health-related quality of life in children with asthma.

Evaluating the Role of a Socially Assistive Robot in Children's Mental Health Care

Socially assistive robots (SARs) present a promising intervention for addressing the increasing prevalence of childhood stress. This innovative technology has become increasingly common in practical implementation. However, empirical support has not kept pace with the robots' growing popularity. The present study set out to provide an empirical test of the stress-buffering capability of this technology. We examined the effects of the presence of an SAR on self-reported measures of stress in a community sample of 70 children (40 girls, 30 boys) between the ages of 7 and 10 years old. Child participants were randomly assigned to either a robot-present or a robot-absent condition during the Trier Social Stress Test for Children. Contrary to our predictions, we did not detect a stress-buffering effect of the presence of the robot. Instead, the primary analysis showed that the robot's presence led to a larger decrease in positive affect following the task. However, further analyses found no significant difference in positive affect when accounting for baseline group differences. Exploratory analyses of the nature of children's interactions with the SAR during the stressful task found that higher levels of parent-reported social anxiety were associated with greater prosocial behaviors towards the SAR, thus signifying a potential target for future interventions. Further work on SARs is needed to determine the optimal timing and robotic specifications that would maximize the potential of this developing technology to improve children's mental health care.

A pilot study of a family systems oriented telemental health model in rural Brazil

There are large disparities in access to mental health care, especially in low- and middle-income countries. Telemental health is a viable solution to reducing these disparities, but quality research demonstrating its effectiveness is needed. The purpose of this pilot study was to examine the feasibility of a telemental health approach in a rural region of Brazil. Primary care providers referred patients diagnosed with depression and anxiety to a 12-session family systems-oriented telemental health program developed by the researchers. Participants (n = 10) received therapy by family systems trained therapists. While sessions were delivered via telemental health, each received one face-to-face session as part of the treatment regimen. Results from the one-tailed t-tests indicate reductions in psychosocial symptoms and improvements in family functioning with medium and large effect sizes. Findings reveal that a family systems-oriented telemental health approach is a promising intervention for improving mental health outcomes in a middle-income country.

The Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo): Rationale, Methods, and Baseline Characteristics

Background: The characterization of adolescents at high risk for developing depression has traditionally relied on the presence or absence of single risk factors. More recently, the use of composite risk scores combining information from multiple variables has gained attention in prognostic research in the field of mental health. We previously developed a sociodemographic composite score to estimate the individual level probability of depression occurrence in adolescence, the Identifying Depression Early in Adolescence Risk Score (IDEA-RS). Objectives: In this report, we present the rationale, methods, and baseline characteristics of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo), a study designed for in-depth examination of multiple neurobiological, psychological, and environmental measures associated with the risk of developing and with the presence of depression in adolescence, with a focus on immune/inflammatory and neuroimaging markers. Methods: Using the IDEA-RS as a tool for risk stratification, we recruited a new sample of adolescents enriched for low (LR) and high (HR) depression risk, as well as a group of adolescents with a currently untreated major depressive episode (MDD). Methods for phenotypic, peripheral biological samples, and neuroimaging assessments are described, as well as baseline clinical characteristics of the IDEA-RiSCo sample. Results: A total of 7,720 adolescents aged 14-16 years were screened in public state schools in Porto Alegre, Brazil. We were able to identify individuals at low and high risk for developing depression in adolescence: in each group, 50 participants (25 boys, 25 girls) were included and successfully completed the detailed phenotypic assessment with ascertainment of risk/MDD status, blood and saliva collections, and magnetic resonance imaging (MRI) scans. Across a variety of measures of psychopathology and exposure to negative events, there was a clear pattern in which either the MDD group or both the HR and the MDD groups exhibited worse indicators in comparison to the LR group. Conclusion: The use of an empirically-derived composite score to stratify risk for developing depression represents a promising strategy to establish a risk-enriched cohort that will contribute to the understanding of the neurobiological correlates of risk and onset of depression in adolescence.

Psychometric Properties of the Children's Version of the Spence Children's Anxiety Scale (SCAS) in a Spanish Clinical Sample

The Spence Children's Anxiety Scale (SCAS) has demonstrated good psychometric properties in several countries and cultures. Nevertheless, most of the previous studies that explore these properties have combined clinical and community samples. We aimed to validate the Spanish version of the SCAS in a large clinical sample (N = 130) of children and adolescents. The Spanish adaptation of the SCAS showed good internal consistency for the total scale, and good test-retest reliability for all the subscales. Furthermore, its convergent and discriminant validity were supported by significant correlations with other anxiety questionnaires (Screen for Child Anxiety Related Emotional Disorders [SCARED], Youth Self-Report [YSR] subscales for anxiety disorders and internalizing symptomatology), and lower or non-significant correlations with depression symptoms and externalizing symptoms scales respectively. For the first time in a purely clinical sample, the original factor structure of the SCAS based on six correlated factors was confirmed. Future studies need to evaluate whether the factorial structure of the present instrument is the most suitable for use in clinical populations.

Prevenção de Ansiedade Infantil a partir do Método Friends

Resumo Os Transtornos de Ansiedade têm se desenvolvido com mais frequência em crianças em idade escolar, prejudicando sua saúde, relações sociais e desenvolvimento global. Atualmente, tem-se buscado a prevenção desses transtornos. O Método FRIENDS, programa que visa prevenir ansiedade e depressão por meio do desenvolvimento de habilidades socioemocionais, resiliência e comportamentos para uma vida saudável, é uma possibilidade de intervenção. Nesse contexto, esta pesquisa objetivou verificar se a sintomatologia de ansiedade de crianças diminui após a participação destas no Método FRIENDS. Participaram do estudo 19 crianças, com idades entre 5 e 7 anos, de ambos os sexos. Foi utilizado como instrumento de avaliação o Spence Children’s Anxiety Scale, respondido pelos pais em pré-teste, pós-teste e follow up. Os dados foram comparados a partir de estatística descritiva e inferencial. Os resultados apontam para a diminuição do total de sintomas de ansiedade nas crianças que participaram do método logo após e no seguimento de dois meses.

Validation of the parent report version of the Spence Children's Anxiety Scale (SCAS-P) for Spanish children

Although Spence Children's Anxiety Scale (SCAS) is a widely used anxiety measure in many countries around the world, until now, research has barely focused on the usefulness of the parent version (SCAS-P) in young children. This study examines the psychometric properties and the factor structure of the SCAS-P in a Spanish community sample of 181 children aged 6-8 years (M = 6.87, SD = 0.78). Confirmatory factor analysis showed a good fit of the original six-factor model to the Spanish sample. The internal consistency and the test-retest reliability of the scale were high. Regarding the validity of this measure, higher and significant correlations between the SCAS-P and internalizing problems and lower correlations with externalizing problems were obtained, as found in the original version. Girls seemed to show more anxiety problems than boys, but no significant differences were found. The results suggest that the SCAS-P is an adequate measure to assess anxious symptomatology in young children. The availability of measures with good psychometric properties allows psychologists to assess and carry out a correct and early diagnosis of anxiety disorders in children, making possible an early clinical intervention.

Symptoms of anxiety and depression in schoolchildren with and without developmental coordination disorder

We examined whether reported higher frequencies of anxiety and depression symptoms are related to the presence of developmental coordination disorder in school-age Brazilian children. A total of 272 children were assigned to six groups according to age and motor performance. The Movement Assessment Battery for Children-Second Edition evaluated the motor performance. The Spence Children's Anxiety Scale and the Child Depression Inventory assessed anxiety and depression symptoms, respectively. Brazilian children are at high risk for anxiety, regardless of motor performance and age. However, children with developmental coordination disorder report significantly more depressive symptomatology in 10-12 years compared to typically developing children.

The utility of the SCAS-C/P to detect specific anxiety disorders among clinically anxious children

Questionnaire measures offer a time and cost-effective alternative to full diagnostic assessments for identifying and differentiating between potential anxiety disorders and are commonly used in clinical practice. Little is known, however, about the capacity of questionnaire measures to detect specific anxiety disorders in clinically anxious preadolescent children. This study aimed to establish the ability of the Spence Children's Anxiety Scale (SCAS) subscales to identify children with specific anxiety disorders in a large clinic-referred sample (N = 1,438) of children aged 7 to 12 years. We examined the capacity of the Separation Anxiety, Social Phobia, Generalized Anxiety, and Physical Injury Fears (phobias) subscales to discriminate between children with and without the target disorder. We also identified optimal cutoff scores on subscales for accurate identification of children with the corresponding disorder, and examined the contribution of child, mother, and father reports. The Separation Anxiety subscale was able to accurately identify children with separation anxiety disorder, and this was replicated across all 3 reporters. Mother- and father-reported Social Phobia subscales also accurately identified children with social anxiety disorder, although child report was only able to accurately detect social anxiety disorder in girls. Using 2 or more reporters improved the sensitivity of the Separation Anxiety and Social Phobia subscales but reduced specificity. The Generalized Anxiety and Physical Injury Fears subscales failed to accurately identify children with the corresponding disorders. These findings have implications for the potential use of mother-, father-, and child-report SCAS subscales to detect specific disorders in preadolescent children in clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Identifying children with anxiety disorders using brief versions of the Spence Children's Anxiety Scale for children, parents, and teachers

Anxiety disorders are among the most prevalent mental health disorders experienced by children and are associated with significant negative outcomes. Only a minority of affected children, however, access professional help, and a failure to identify children with anxiety disorders presents a key barrier to treatment access. Existing child anxiety questionnaire measures are long and time consuming to complete, limiting their potential for widespread use as identification tools in community settings. We developed a brief questionnaire for parents, children, and teachers using items from the Spence Children’s Anxiety Scale (SCAS) and evaluated the new measure’s psychometric properties, capacity to discriminate between a community (n = 361) and clinic-referred sample (n = 338) of children aged 7–11, and identified optimal cut-off scores for accurate identification of preadolescent children experiencing clinically significant levels of anxiety. The findings provided support for the reliability and validity of 8-item versions of the SCAS, with the brief questionnaire scores displaying comparable internal consistency, agreement among reporters, and convergent/divergent validity to the full-length SCAS scores. The brief SCAS scores also discriminated between the community and clinic-referred samples and identified children in the clinic-referred sample with a moderate-to-good level of accuracy and acceptable sensitivity and specificity. Combining reporters improved sensitivity, but at the expense of specificity, and findings suggested parent report should be prioritized. This new brief questionnaire has potential for use in community settings as a tool to improve identification of children who are experiencing clinically significant levels of anxiety and warrant further assessment and potential support.

We developed and evaluated brief versions of the Spence Children’s Anxiety Scale for parents, children, and teachers. Results provide support for the potential application of this new brief questionnaire in community settings to improve identification of children with anxiety disorders.

Negative Life Events, Social Support, and Self-Efficacy in Anxious Adolescents

PURPOSE

To examine the prevalence and correlates of anxiety in a community sample of adolescents. Knowing the prevalence and characteristics of anxious adolescents is valuable to improve anxiety prevention strategies and interventions.

DESIGN

Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12-17 (N = 1719).

METHODS

Based on scores from the Spence Children's Anxiety Scale, the adolescents were categorized as not anxious or anxious. Logistic regression analysis was performed to access the impact of each factor on the likelihood that participants would report an elevated level of anxiety.

RESULTS

A total of 22% of the adolescents were categorized as anxious. Female gender, experienced negative life events, low social support, and low self-efficacy were associated with elevated level of anxiety.

CONCLUSIONS

The high prevalence of anxiety in adolescents demonstrates the importance of improved prevention interventions targeting anxious adolescents. We argue that addressing is the responsibility of not only the individual adolescents and their families but also schools, school health services, and policy makers. School-based interventions that increase social support and self-efficacy would probably be particularly beneficial for anxious adolescents.

Specific and social fears in children and adolescents: separating normative fears from problem indicators and phobias

Objective:

To distinguish normative fears from problematic fears and phobias.

Methods:

We investigated 2,512 children and adolescents from a large community school-based study, the High Risk Study for Psychiatric Disorders. Parent reports of 18 fears and psychiatric diagnosis were investigated. We used two analytical approaches: confirmatory factor analysis (CFA)/item response theory (IRT) and nonparametric receiver operating characteristic (ROC) curve.

Results:

According to IRT and ROC analyses, social fears are more likely to indicate problems and phobias than specific fears. Most specific fears were normative when mild; all specific fears indicate problems when pervasive. In addition, the situational fear of toilets and people who look unusual were highly indicative of specific phobia. Among social fears, those not restricted to performance and fear of writing in front of others indicate problems when mild. All social fears indicate problems and are highly indicative of social phobia when pervasive.

Conclusion:

These preliminary findings provide guidance for clinicians and researchers to determine the boundaries that separate normative fears from problem indicators in children and adolescents, and indicate a differential severity threshold for specific and social fears.

The Parent-Version of the Spence Children's Anxiety Scale (SCAS-P) in Chinese and Italian Community Samples: Validation and Cross-Cultural Comparison

The current study aimed to validate the parent-version of the Spence Children's Anxiety Scale (SCAS-P) among Chinese and Italian community adolescents and to compare adolescents' anxiety symptoms in these two countries. Chinese (N = 456) and Italian (N = 452) adolescents and their parents participated in the study. Results showed that: (1) the six correlated-factor structure was demonstrated and invariant across countries. (2) The reliability of the total scale was good in both samples, whereas reliabilities of subscales were acceptable and moderate in Chinese and Italian samples, respectively. (3) The SCAS-P showed good convergent and divergent validity. (4) Adolescent-parent agreement was from low to medium while mother-father agreement ranged from medium to high. (5) There were cultural and gender differences in levels of parent-report anxiety symptoms. In conclusion, SCAS-P seems to be a promising parent-report instrument to assess Chinese and Italian adolescents' anxiety symptoms.

DSM-IV-defined anxiety disorder symptoms in a middle-childhood-aged group of Malaysian children using the Spence Children's Anxiety Scale

INTRODUCTION

Pediatric anxiety disorders are the most common mental health disorders in the middle-childhood age group. The purpose of this study is to assess anxiety disorder symptoms, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), in a large community sample of low socioeconomic level rural children and to investigate some of the psychometric properties (internal consistency, construct and convergent validity and items rated as often or always experienced) of the Malay version of the Spence Children's Anxiety Scale - Child version (SCAS-C).

METHOD

Six hundred children aged 9-11 and 424 of their parents completely answered the child or parent versions of the SCAS.

RESULTS

Results indicated that the internal reliability of subscales were moderate to adequate. Significant correlations between child and parent reports supported the measure's concurrent validity. Additionally, anxiety levels in this Malaysian sample were lower than among South-African children and higher than among their Western peers. There were both similarities and differences between symptom items reported as often or always experienced by Malaysian students and by children from other cultures. Confirmatory factor analysis provided evidence of the existence of five inter-correlated factors for anxiety disorders based on SCAS-C.

CONCLUSION

Although some of the instrument's psychometric properties deviated from those observed in some other countries, it nevertheless appears to be useful for assessing childhood anxiety symptoms in this country.

A systematic review of the factor structure and reliability of the Spence Children's Anxiety Scale

BACKGROUND

The Spence Children's Anxiety Scale (SCAS) is a widely used instrument for assessing symptoms of anxiety disorders among children and adolescents. Previous studies have demonstrated its good reliability for children and adolescents from different backgrounds. However, remarkable variability in the reliability of the SCAS across studies and inconsistent results regarding its factor structure has been found.

METHODS

The present study aims to examine the SCAS factor structure by means of a systematic review with narrative synthesis, the mean reliability of the SCAS by means of a meta-analysis, and the influence of the moderators on the SCAS reliability. Databases employed to collect the studies included Scholar Google, PsycARTICLES, PsycINFO, Web of Science, and Scopus since 1997.

RESULTS

Twenty-nine and 32 studies, which examined the factor structure and the internal consistency of the SCAS, respectively, were included. The SCAS was found to have strong internal consistency, influenced by different moderators. The systematic review demonstrated that the original six-factor model was supported by most studies.

LIMITATIONS

Factorial invariance studies (across age, gender, country) and test-retest reliability of the SCAS were not examined in this study.

CONCLUSIONS

It is concluded that the SCAS is a reliable instrument for cross-cultural use, and it is suggested that the original six-factor model is appropriate for cross-cultural application.

Assessing Adolescent Anxiety in General Psychiatric Care: Diagnostic Accuracy of the Swedish Self-Report and Parent Versions of the Spence Children's Anxiety Scale

This study examined the psychometric properties and diagnostic accuracy of the Swedish translations of the Spence Children's Anxiety Scale, self- and parent report versions, in a sample of 104 adolescents presenting at two general psychiatric outpatient units. Results showed high informant agreement and good internal reliability and concurrent and discriminant validity for both versions and demonstrated that this scale can distinguish between adolescents with and without an anxiety disorder in a non-anxiety-specific clinical setting. The relative clinical utility of different cutoff scores was compared by looking at the extent to which dichotomized questionnaire results altered the pretest probability of the presence of a diagnosis as defined by the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Optimized for screening and diagnostic purposes in Sweden, cutoff scores obtained in the current study outperformed a previously identified cutoff score derived from an Australian community sample. The Spence Children's Anxiety Scale is a useful clinical instrument for the assessment of anxiety in adolescents.