From the Guidelines
The Screen for Child Anxiety Related Emotional Disorders (SCARED) is the most recommended assessment tool for evaluating anxiety in children, as it has strong psychometric properties and can be completed by both children and their parents. This 41-item questionnaire effectively screens for various anxiety disorders, including generalized anxiety disorder, separation anxiety, social anxiety, panic disorder, and school avoidance 1. The SCARED typically takes 10-15 minutes to complete and uses a simple 0-2 scoring system, with higher scores indicating greater anxiety symptoms. A total score of 25 or higher suggests the presence of an anxiety disorder warranting further evaluation.
Some of the key benefits of using the SCARED include:
- High internal consistency, test-retest reliability, and good discriminant validity
- Translated into multiple languages and validated across diverse populations
- Can be used to evaluate the impact of broad and specifically targeted treatments on broad and specific subscales
- Provides valuable perspectives from multiple sources, including both children and their parents
Other assessment tools, such as the Spence Children’s Anxiety Scale (SCAS) and the Preschool Anxiety Scale, may also be useful in evaluating anxiety in children, but the SCARED is generally considered the most comprehensive and widely used tool 1. The Generalized Anxiety Disorder 7 (GAD-7) is also a useful tool, but it is typically used for teens and adults, rather than children 1.
For implementation, clinicians should explain to both children and parents that honest responses are essential for accurate assessment, and results should be interpreted alongside clinical interviews and observations for a comprehensive evaluation of the child's anxiety symptoms. As recommended by recent research reviews, a multidimensional measure of anxiety symptoms, such as the SCARED, should be included in the assessment, even when the trial targets a specific anxiety disorder 1.
From the Research
Assessment Tools for Anxiety in Children
The Multidimensional Anxiety Scale for Children (MASC) is a widely used self-report questionnaire for assessing anxiety symptoms in children and adolescents.
- The MASC has been found to have excellent internal reliability and a factor structure that is invariant across gender and age 2.
- The scale consists of 39 items distributed across four major factors: physical symptoms, social anxiety, harm avoidance, and separation anxiety 2.
- Studies have shown that the MASC has good convergent and divergent validity, with high shared variance with scales sampling symptom domains of interest 2, 3.
- However, the MASC may not be a valid screening instrument for DSM-IV diagnoses, with the total score not exceeding the threshold for being judged as fair in predicting any ADIS-C/DSM-IV anxiety diagnosis 4.
- The Social Anxiety and Separation/Panic subscales of the MASC have been found to be significantly predictive of the presence and severity of social phobia and separation anxiety disorder, respectively 5.
- Using multiple informants, such as parent and child reports, can improve the accuracy of prediction 5, 3.
- The MASC has been found to be a clinically useful measure to discriminate between anxious and depressed pediatric patients 6.
Limitations and Considerations
- Low parent-child agreement has been found on the MASC, which may limit its use as a screening instrument 4, 3.
- The MASC may not be suitable for all populations, such as highly selective samples 6.
- Further research is needed to fully understand the psychometric properties and clinical utility of the MASC in different populations and settings 2, 5, 3, 6.