Best Screen for Pediatric Anxiety Disorders
For pediatric anxiety screening, use the SCARED (Screen for Child Anxiety Related Emotional Disorders) in both parent and child versions, with the parent version demonstrating superior sensitivity and specificity. 1
Primary Screening Recommendation
The American Academy of Child and Adolescent Psychiatry specifically recommends the SCARED as the first-line screening tool for children and adolescents with anxiety disorders. 1 This instrument is:
- Freely available at https://www.pediatricbipolar.pitt.edu/resources/instruments 1
- Validated across multiple versions (38-, 41-, 66-, 69-, and 71-item formats) with excellent psychometric properties 2
- Effective across age ranges, including early childhood (ages 4-7), middle childhood, and adolescence 3
Why SCARED Over Other Options
The parent version of SCARED is the optimal choice because it displays better sensitivity and specificity compared to the child version and can discriminate reasonably well among specific anxiety disorders. 4 Meta-analysis of 65 studies demonstrates:
- Excellent internal consistency on total scores and major subscales (panic disorder, generalized anxiety, separation anxiety, social anxiety) 2
- Moderate to large test-retest reliability and parent-child agreement rates 2
- Strong discriminant validity, with anxious children scoring significantly higher than those with depression-only or disruptive disorders 5
- Treatment sensitivity, reliably detecting symptom changes from pre- to post-treatment 6
Age-Specific Screening Algorithm
For Preschool-Age Children (Under 6 Years)
- Use the Preschool Anxiety Scale (parent version only) 1
- Available at https://www.scaswebsite.com 1
For School-Age Children and Adolescents (6-18 Years)
- Use SCARED in both parent and child versions 1
- Administer both versions simultaneously for comprehensive assessment 4
- Girls typically report higher anxiety levels, and age effects exist across subscales 4
For Older Adolescents (Teen/Young Adult)
- GAD-7 (Generalized Anxiety Disorder-7) can be used as an alternative 1, 7
- Available at https://www.phqscreeners.com 1
Alternative Validated Screening Tool
The Spence Children's Anxiety Scale (SCAS) is an equally acceptable alternative with similar psychometric properties, available in parent and child versions at https://www.scaswebsite.com. 1 However, SCARED has more extensive validation research supporting its use. 2
When to Use Structured Diagnostic Interviews Instead
Screening tools are not diagnostic—they support but do not replace clinical assessment. 1, 7 For definitive diagnosis, consider:
- ADIS (Anxiety Disorders Interview Schedule): The gold standard in research settings, addressing all DSM anxiety disorders plus comorbidity screening 1
- K-SADS-PL DSM-5: Freely available structured interview covering panic, agoraphobia, separation anxiety, social anxiety, selective mutism, specific phobia, and generalized anxiety 1
Implementation in Different Settings
Primary Care or School Settings
Deploy general social-emotional screening first (Pediatric Symptom Checklist or Strengths and Difficulties Questionnaire), then follow positive screens with SCARED for anxiety-specific assessment. 1
Psychiatric Evaluation Settings
Include SCARED in intake packets along with the APA's Level 1 Cross-Cutting Symptom Measures to systematically gather information before the evaluation appointment. 1
Critical Pitfalls to Avoid
- Never rely solely on screening scores for diagnosis—they identify concerns requiring follow-up clinical assessment 1, 7
- Don't use child version alone—the parent version has superior diagnostic accuracy 4
- Avoid ignoring subscale limitations—school avoidance, obsessive-compulsive disorder, blood phobia, and situational phobia subscales show inadequate reliability for screening purposes 2
- Don't skip multi-informant assessment—gather information from the child, parents, and when appropriate, teachers 7, 8