Adolescent Life Interference Scale for Internalizing Symptoms (ALIS-I)

Abstract

The Adolescent Life Interference Scale for Internalizing Symptoms (ALIS-I; Schniering et al., 2023) is a 22-item self-report questionnaire designed to quantitatively assess the degree of functional impairment experienced by adolescents due to internalizing disorders, specifically symptoms related to anxiety and depression. The instrument was developed to fulfill a critical need for an impairment measure tailored specifically for this population and these types of symptoms.

The development process began by generating an initial pool of 30 items derived from existing literature on impairment domains—such as education, peer relationships, and parental interactions—combined with clinical expertise. Following expert review and piloting across clinical and non-clinical adolescent samples in the U.S. and Australia, an Exploratory Factor Analysis (EFA) reduced the scale to 22 items, revealing a robust four-factor structure. Subsequent psychometric evaluations confirmed the scale’s high internal consistency, moderate test-retest reliability, and strong convergent and discriminant validity.

Keywords

Adolescent Anxiety, Adolescent Depression, Internalizing Disorders, Peer Problems, Problems with Study/Work, Somatic Problems, Withdrawal/Avoidance, Functional Impairment, Adolescent Psychopathology, Anxiety Disorders, Avoidance, Functional Status, Major Depression, Somatization, Academic Stress, Internalizing Symptoms, Mental Health and Illness Assessment, Youth Mental Health

Authors

Schniering, Carolyn A., Forbes, Miriam K., Rapee, Ronald M., Wuthrich, Viviana M., Queen, Alexander H., Ehrenreich-May, Jill

Purpose

The primary objective of the ALIS-I is to provide a specific, reliable measure for quantifying the extent to which internalizing symptoms interfere with the daily life and functioning of adolescents. This allows clinicians and researchers to gauge the severity of the real-world impact of conditions such as anxiety and depression beyond symptom count alone.

The scale focuses on capturing interference across crucial developmental domains relevant to youth, ensuring that assessment of impairment is ecologically valid and sensitive to changes resulting from therapeutic intervention.

Construct

The ALIS-I measures the construct of Functional Impairment specifically resulting from internalizing symptoms in adolescents (aged 11-18). Functional impairment is operationalized as the difficulty or inability to perform age-appropriate activities across key life domains, including academic or occupational functioning, social interactions (peer problems), and general well-being (somatic problems and avoidance behavior).

The scale’s four-factor structure reflects distinct, clinically meaningful facets of impairment: Withdrawal/Avoidance, Somatic Problems, Problems With Study/Work, and Peer Problems. By isolating these specific areas, the ALIS-I provides a nuanced profile of how internalizing psychopathology manifests as interference in an adolescent’s life.

Validity

The ALIS-I demonstrates strong evidence for both convergent and discriminant validity, supporting its use as a specialized measure of impairment.

• Convergent Validity: The scale exhibited high positive correlations with established measures of related psychological constructs. Specifically, strong correlations were observed with the Centre for Epidemiological Studies Depression Scale (CESD; r = 0.81, p < 0.0005), the Spence Children’s Anxiety Scale (SCAS; r = 0.68, p < 0.0005), and the negative affect subscale of the Positive and Negative Affect Scale (PANAS; r = 0.80, p < 0.0005). These findings confirm that the ALIS-I is accurately measuring a construct closely aligned with established measures of depression and anxiety severity.
• Discriminant Validity: The ALIS-I successfully discriminated between clinical and non-clinical adolescent samples. Clinical participants consistently reported significantly higher mean scores across the total scale and all subscales when compared to the control group. The observed effect sizes for these differences ranged from medium to large, indicating the scale’s effectiveness in differentiating individuals based on clinical status.

Reliability

The reliability assessment of the ALIS-I included both measures of internal consistency and stability over time.

• Internal Consistency: The total ALIS-I scale demonstrated high internal consistency, with McDonald’s omega (ω) reported as 0.94. This high value suggests excellent coherence among the 22 items. Internal consistency scores for the individual subscales were also strong, ranging from moderate to high, indicating that the items within each factor reliably measure their intended sub-construct.
• Test-Retest Reliability: Test-retest reliability was evaluated over an 8-12 week interval using intraclass correlation coefficients (ICC). The total scale and three of the four subscales demonstrated moderate stability over this period. However, the Peer Problems subscale showed comparatively lower test-retest reliability, which the authors attributed to relatively limited variability observed within that specific subscale in the study sample.

Factor Analysis

The factor structure of the ALIS-I was established through Exploratory Factor Analysis (EFA). Initial analyses considered both four- and five-factor models. The four-factor structure was ultimately selected as the optimal model, demonstrating greater stability and yielding factors that were deemed more clinically meaningful and interpretable.

The final 22 items were selected based on a criterion requiring a factor loading greater than 0.4 on at least one of the four emerging factors. A subsequent EFA confirmed the stability and integrity of the final four-factor model, which consists of Withdrawal/Avoidance, Somatic Problems, Problems With Study/Work, and Peer Problems.

Instrument

Test Type: Original

Format: The ALIS-I is a self-report questionnaire consisting of 22 items. Respondents are instructed to rate the frequency of experiencing each life interference item over the past month using a 5-point frequency scale (0 = not at all, 1 = sometimes, 2 = fairly often, 3 = often, 4 = all the time). Higher cumulative scores indicate a greater degree of functional impairment.

Language Available: English

Population Group: Human (Male, Female)

Age Group: Childhood (birth-12 yrs), School Age (6-12 yrs), Adolescence (13-17 yrs), Adulthood (18 yrs & older)

Population Details: The scale was validated using clinical and non-clinical adolescents aged 11–18 years, sampled from both Australia and the United States.

Test Methodology: The development and validation involved comprehensive psychometric methodologies, including Test Validity, Convergent Validity, Discriminant Validity, Test Reliability, Internal Consistency, Test-Retest Reliability, Factor Analysis, and Exploratory Factor Analysis.

Keywords

Adolescent Anxiety, Adolescent Depression, Internalizing Disorders, Functional Impairment, Psychopathology, Test Reliability, Test Validity, Academic Stress, Somatization, Youth Mental Health

Authors

Author Details:

• Schniering, Carolyn A.: ORCID Identifier: No data is Available. Affiliation: Macquarie University, Department of Psychology, Centre for Emotional Health.
• Forbes, Miriam K.: ORCID Identifier: orcid.org/0000-0002-6954-3818. Affiliation: Macquarie University, Department of Psychology, Centre for Emotional Health.
• Rapee, Ronald M.: ORCID Identifier: orcid.org/0000-0002-1724-1076. Affiliation: Macquarie University, Department of Psychology, Centre for Emotional Health.
• Wuthrich, Viviana M.: ORCID Identifier: orcid.org/0000-0001-7227-229X. Affiliation: Macquarie University, Department of Psychology, Centre for Emotional Health.
• Queen, Alexander H.: ORCID Identifier: No data is Available. Affiliation: Tufts University, Department of Psychology.
• Ehrenreich‑May, Jill: ORCID Identifier: No data is Available. Affiliation: University of Miami, Department of Psychology.

Affiliation Email addresses: [email protected]; [email protected]

Correspondence Address: Schniering, Carolyn A.: Macquarie University, Department of Psychology, Centre for Emotional Health, Sydney, New South Wales, Australia, 2109, [email protected]

Permissions & Fee and Test Year

• Permissions: Contact Corresponding Author
• Commercial: No
• Fee: No
• Test Year: 2023

Reference’s

Schniering, C. A., Forbes, M. K., Rapee, R. M., Wuthrich, V. M., Queen, A. H., & Ehrenreich-May, J. (2023). Assessing functional impairment in youth: Development of the Adolescent Life Interference Scale for Internalizing Symptoms (ALIS‑I). Child Psychiatry and Human Development, 54(2), 508–519. doi.org/10.1007/s10578-021-01241-3

The original publication can be accessed via its digital object identifier (DOI) link: doi.org/10.1007/s10578-021-01241-3

Items of the Adolescent Life Interference Scale for Internalizing Symptoms (ALIS-I)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

No test items are available in the provided text.