What validated anxiety rating scales are recommended for assessing anxiety in children and adolescents?

Validated Anxiety Rating Scales for Children and Adolescents

Primary Recommendation

Use the SCARED (Screen for Child Anxiety Related Emotional Disorders) as your first-line screening tool for children and adolescents with anxiety disorders, with the parent version demonstrating superior sensitivity and specificity. 1

Age-Specific Selection Algorithm

Preschool Children (Under 6 Years)

• Use the Preschool Anxiety Scale (parent version only), as standard measures like SCARED are not validated for this age group 1
• Available at https://www.scaswebsite.com 1

School-Age Children and Adolescents (6-18 Years)

• Administer SCARED in both parent and child versions to capture multi-informant perspectives 1
• The SCARED is freely available at https://www.pediatricbipolar.pitt.edu/resources/instruments 1
• Parent-child agreement on anxiety symptoms is typically low to moderate, making dual reporting essential 2

Older Adolescents (Teen/Young Adult)

• The GAD-7 (Generalized Anxiety Disorder-7) can serve as an alternative for this age group 1
• Available at https://www.phqscreeners.com 1

Equally Valid Alternative: Spence Children's Anxiety Scale (SCAS)

The SCAS is an equally acceptable alternative with similar psychometric properties to SCARED, available in both parent and child versions 1

Evidence Supporting SCAS

• The six-factor model structure is well-supported across most populations, covering separation anxiety, social phobia, obsessive-compulsive disorder, panic-agoraphobia, generalized anxiety, and fears of physical injury 3, 4
• Demonstrates high internal consistency for total scores and subscales, with satisfactory 12-week test-retest reliability 4
• Brief 8-item versions show comparable psychometric properties to full-length versions, with moderate-to-good accuracy in discriminating community from clinic-referred samples 5
• Parent report should be prioritized when using brief versions, as combining reporters improves sensitivity but reduces specificity 5
• Available at https://www.scaswebsite.com 1

Additional Validated Measure: MASC

The Multidimensional Anxiety Scale for Children (MASC) demonstrates good psychometric properties and clinical utility, particularly for identifying specific anxiety disorder subtypes 6

• The Social Anxiety and Separation/Panic subscales significantly predict the presence and severity of social phobia and separation anxiety disorder, respectively 6
• Using multiple informants (parent and youth) improves prediction accuracy 6
• Validated in special populations including youth with learning disabilities 7

When to Use Structured Diagnostic Interviews

For definitive diagnosis rather than screening, use structured diagnostic interviews that systematically assess DSM criteria 8

Gold Standard Options

• The ADIS (Anxiety Disorders Interview Schedule) is the gold standard in research settings, addressing all DSM anxiety disorders plus comorbidity screening 1, 8
• The K-SADS-PL DSM-5 is a freely available structured interview covering panic, agoraphobia, separation anxiety, social anxiety, selective mutism, specific phobia, and generalized anxiety 1
• These interviews provide Clinician Severity Ratings (CSRs) that offer both diagnostic determination and severity assessment 8

Multidimensional Approach for Treatment Trials

Include a multidimensional measure of anxiety symptoms that provides both a total anxiety score and disorder-specific subscales, even when targeting a specific anxiety disorder 2

• This approach allows evaluation of both broad anxiety symptoms and specific anxiety domains 2
• When focusing on a specific anxiety disorder, add a disorder-focused measure in addition to the broader measure 2
• Ensure the measure can discriminate between clinical and nonclinical anxiety levels and is sensitive to treatment gains 2

Implementation Strategy by Setting

Primary Care or School Settings

• Deploy general social-emotional screening first, 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

• Screening tools identify concerns requiring follow-up clinical assessment, not definitive diagnoses 1, 8
• Structured diagnostic interviews are required to establish anxiety disorder diagnoses by assessing DSM criteria 8

Always Use Multi-Informant Assessment

• Gather information from the child, parents, and when appropriate, teachers 1
• Parent-child agreement is typically low to moderate, necessitating multiple perspectives 2

Report Appropriately

• Report mean raw scores and standard deviations rather than standardized scores (T-scores) due to significant variability in normative data across ages and sexes 2
• When using measures that conflate symptoms and interference in a total score, report item-level data separately 2

Consider Psychometric Limitations

• Most measures were developed with children aged 8-17 years from white, two-parent families of relatively high socioeconomic status 2
• Limited data exist on sensitivity and specificity of clinical cutoff points for determining diagnostic status 2
• Evidence suggests commonly used measures are robust across particular ethnic groups, though continued research is needed 2