Screen for Child Anxiety Related Emotional Disorders Child Version (SCARED Child)

Description
The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a parent and child self-report scale used to screen for anxiety disorders in children (aged 8-18 years), including generalised anxiety, separation anxiety disorder, panic disorder and social phobia (Birmaher et al., 1997). The child version asks the child questions about themselves. The SCARED consists of 41 items and has five factors that correspond with anxiety disorders outlined in the DMS-IV:
1) Somatic/panic
2) General anxiety
3) Separation anxiety
4) Social phobia
5) School phobia

The scale is designed to be used by clinicians as an screener for anxiety disorders in children, and can be used to track symptoms over time.

If a child is aged between 8-11 years it is recommended that the clinician explain all questions, or have the child answer the questionnaire sitting with an adult in case they have any questions.
It is recommended that both the parent and child version of the SCARED are administered due to the moderate correlation between the two versions.

Validity
The 41 item version of the SCARED was developed by Birmaher and colleagues (1999). The scale was administered to 190 children and adolescents attending an outpatient mood/anxiety disorders clinic and their parents. The 190 children and adolescents were diagnosed with either an ‘anxiety’ (n = 45) or ‘nonanxiety’ (n = 145) disorder by a trained clinician.

Factor analysis yielded five subscales; (somatic/panic, general anxiety, separation anxiety, social phobia and school phobia). Moderate correlations were found between the parent and child version (Birmaher et al., 1999). A cut-off score for the total score and each subscale was suggested by the test developers and were chosen based on scores which yielded the highest sensitivity and specificity.

The sample of 45 children and adolescents with anxiety disorders (aged 9 -19) had a mean total score of 36.1 (17.3), a mean somatic/panic score of 9.4 (6.6), a mean general anxiety score of 9.4 (5.8), a mean separation anxiety score of 5.4 (4.0), a mean social phobia score of 8.0 (4.2) and a mean school phobia score of 3.9 (2.7) (Birmaher et al., 1999).

A non-clinical community sample of 521 children and adolescents, aged 12-18, had a mean total score of 16.1 (12.6), a mean somatic/panic score of 2.8 (3.9), a mean general anxiety score of 4.9 (4.3), a mean separation anxiety score of 2.4 (2.5), a mean social phobia score of 4.8 (3.7) and a mean school phobia score of 1.2 (1.6) (Muris et al., 200).

The SCARED has demonstrated good discriminate validity. Findings indicated that the total score and score for each of the five factors of the child SCARED significantly differentiated children with anxiety disorders from children with other disorders. Similar results were found for the total score and the panic/somatic and separation anxiety factor scores of the parent SCARED. For the most part scales on both the parent and child version of the SCARED were also able to significantly differentiate between anxiety disorders (Birmaher et al., 1999).

Many studies have confirmed the validity and reliability of the SCARED in both clinical and community samples (Hale et al., 2011).

Interpretation
Items are summed to obtain an overall total score and a score for each of the five subscales. Higher scores indicate higher levels of anxiety.

A total score of 25 or more may indicate the presence of an anxiety disorder. Panic disorder or significant panic symptoms. Items 1, 6, 9, 12, 15, 18, 19, 22, 24, 27, 30, 34, 38. A score of 7 or above may indicate the presence of panic disorder or significant somatic symptoms.

Generalised anxiety disorder. Items 5, 7, 14, 21, 23, 28, 33, 35, 37. A score of 9 or above may indicate the presence of panic disorder

Separation Anxiety. Items 4, 8, 13, 16, 20, 25, 29, 31. A score of 5 or above may indicate separation anxiety.

Social Phobia. Items 3, 10, 26, 32, 39, 40, 41. A score of 8 or above may indicate social phobic disorder.

School avoidance. Items 2, 11, 17, 36. A score of 3 or above may indicate school avoidance.

Two percentiles are presented to indicate how the SCARED Child Version scores compare to a group of children and adolescents with a diagnosed anxiety disorder and a community sample. A percentile of 50 compared to the Anxiety Sample is typical for children presenting with an anxiety disorder, which will correspond to a percentile compared to the Community Sample of approximately 95.

Developer
Birmaher, B., Khetarpal, S., Cully, M., Brent, D., & McKenzie, S. (1995). Western Psychiatric Institute and Clinic, University of Pittsburgh.

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