Screen for Child Anxiety Related Emotional Disorders (SCARED)

Abstract

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a widely utilized, 38-item self-report and parent-report instrument designed for screening children and adolescents (ages 8 to 18 years) for anxiety disorders. Originally developed in the United States by Birmaher et al. (1997), the scale is rooted in the DSM-IV classification system for anxiety disorders.

The SCARED is structured around five distinct factors that correspond closely to major diagnostic categories: Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Separation Anxiety Disorder (SAD), and Social Phobia (SP), along with a fifth factor covering School Anxiety/Phobia. The scale has demonstrated robust psychometric properties, including good internal consistency and strong test-retest reliability, making it a reliable tool for clinicians and researchers in identifying youth who require further diagnostic evaluation for anxiety.

Keywords

Anxiety, Screening, Child, Adolescent, DSM-IV, Psychometrics, Internalizing Disorders, Panic Disorder, Social Phobia, Separation Anxiety Disorder.

Authors

Birmaher, B., Khetarpal, S., Brent, D., Cully, Balach, L., Kaufman, J., & McKenzie Neer, S. (1997).

Purpose

The primary purpose of the SCARED is to serve as an efficient screening tool for identifying the presence and severity of anxiety-related emotional disorders in children and adolescents aged 8 to 18 years. It is specifically designed to help clinicians and psychiatrists rapidly determine which patients referred to mood/anxiety disorders clinics may meet criteria for specific DSM-IV-TR anxiety disorders.

The instrument provides both a total anxiety score and subscale scores, allowing for differentiation among various anxiety symptom dimensions. Furthermore, recent research suggests its utility extends beyond traditional psychiatric settings, showing promise as a measure of anxiety levels in populations dealing with paediatric chronic pain.

Construct

The SCARED measures the psychological construct of anxiety symptoms as defined by the criteria established in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The original 85-item pool was developed based on the DSM-IV classification, which was subsequently refined into the final 38-item version.

The scale is unique in its ability to map symptoms onto specific clinical anxiety dimensions. It captures five core factors of anxiety experienced by youth: Somatic/Panic symptoms, Generalized Anxiety, Separation Anxiety, Social Phobia, and School Phobia. While the first four factors align directly with formal DSM diagnostic categories, the inclusion of School Phobia addresses a common and clinically significant anxiety manifestation in this age group, even though it is not classified as a standalone anxiety disorder in the DSM-IV-TR or DSM-5.

Validity

The SCARED has demonstrated strong evidence of both convergent and discriminant validity across multiple studies. The initial validation work (Birmaher et al., 1997) confirmed its ability to differentiate between anxiety disorders and other common childhood disorders.

• Discriminant Validity: Children diagnosed with an anxiety disorder scored significantly higher on the SCARED than children diagnosed solely with depression or disruptive disorders, confirming its specificity for anxiety symptomology.
• Convergent Validity: The SCARED showed significant correlations with established measures of internalizing distress. Specifically, it correlated better with the internalizing factors of the Child Behaviour Checklist (CBCL) than with externalizing factors. Both the child and parent SCARED forms also correlated significantly with the trait and state subscales of the State-Trait Anxiety Inventory for Children (STAIC).
• Cross-Cultural Validity: A meta-analysis examining 25 cross-cultural studies (Hale et al., 2011) predominantly from Europe, the USA, South America, and China, confirmed that the psychometric properties of the scales related to the DSM-IV-TR anxiety disorders were robust, suggesting the SCARED is suitable for screening across diverse international populations.

Reliability

The reliability of the SCARED has been consistently demonstrated across both child and parent versions and for all five subfactors. This strong reliability supports its use in clinical and research settings for consistent measurement of anxiety symptoms over time.

• Internal Consistency: Both the child and parent versions exhibited good internal consistency, with Cronbach’s alpha coefficients ranging from .74 to .93 across the total score and the five factors.
• Test-Retest Reliability: The scale demonstrated strong test-retest reliability, with intraclass correlation coefficients ranging from .70 to .90, indicating stability of scores over time.
• Parent-Child Agreement: Moderate levels of agreement were observed between the parent and child reports (r = .20 to .47, p < .001). This moderate agreement is typical for psychopathology measures in youth, reflecting the differential perspective and insight offered by the child versus the caregiver.

Factor Analysis

The development of the SCARED involved rigorous item and factor analyses to distill the initial 85-item questionnaire into the final 38-item instrument. The factor structure consistently yielded five distinct factors in both the child and parent reports, aligning with the symptom dimensions of clinical anxiety.

The five factors identified are: Somatic/Panic (corresponding to Panic Disorder), Generalized Anxiety (corresponding to GAD), Separation Anxiety (corresponding to SAD), Social Phobia (corresponding to SP), and School Phobia/Anxiety. While the first four factors correspond directly to DSM-IV-TR anxiety disorders, the School Phobia factor captures symptoms related to school refusal and anxiety specific to the educational environment.

Instrument

Test Type:

Screening Instrument (Self-report and Parent-report)

Format:

Paper and pencil test, 38 items, 3-point Likert scale (0 = Not true or hardly ever true; 1 = Somewhat true or Sometimes true; 2 = Very true or Often true).

Language Available:

Originally developed in English (US). Numerous translations exist globally due to cross-cultural validation.

Population Group:

Children and Adolescents (Clinically referred and general populations).

Age Group:

8 to 18 years old.

Population Details:

The initial validation sample included 341 outpatient children and adolescents and 300 parents referred to a mood/anxiety disorders clinic. Participants ranged from 9 to 18 years, with 59% female. The initial sample ethnicity was 82% Caucasian and 18% African-American.

Test Methodology:

The test takes approximately 10 minutes to administer and can be immediately scored by summing the items for each scale. Interpretation, which indicates the likely DSM-IV-TR anxiety disorder(s), is provided directly on the form itself, and no separate manual is required.

Keywords

SCARED, Child Anxiety, Panic, GAD, Separation Anxiety, School Refusal, Test Administration, Psychopathology.

Authors

Author ORCID Identifier:

N/A (Not available in source content)

Affiliation Email addresses:

N/A (Not available in source content)

Correspondence Address:

N/A (Not available in source content)

Permissions & Fee and Test Year

The SCARED scale is available at no cost for clinical and research use. Intended users include clinicians and psychiatrists specializing in youth mental health. The scale can be accessed online at the University of Pittsburgh resources. The original scale construction and psychometric characteristics were published in 1997 (Birmaher et al., 1997).

The SCARED is available at no cost at www.wpic.pitt.edu/research under tools and assessments, or at www.pediatricbipolar.pitt.edu under instruments.

Reference’s

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
• Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–6. doi: 10.1097/00004583-199910000-00011
• Birmaher, B., Khetarpal, S., Brent, D., Cully., Balach, L., Kaufman, J., & McKenzie Neer, S. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 545-553. doi: 10.1097/00004583-199704000-00018
• Hale, W. W., Crocetti, E., Raaijmakers, Q. A. W., & Meeus, W. H. J. (2011). A meta-analysis of the cross-cultural psychometric properties of the screen for child anxiety related emotional disorders (SCARED). Journal of Child Psychology and Psychiatry, 52(1), 80-90. doi: 10.1111/j.1469-7610.2010.02285.x
• Jastrowski, M. K. E., Evans, J. R., Tran, S. T., Khan, K. A., Weisman, S. J., & Hainsworth, R. (2012). The psychometric properties of the screen for child anxiety related emotional disorders in pediatric chronic pain. Journal of Pediatric Psychology, 37(9), 999-1011. doi: 10.1093/jpepsy/jsso69
• Monga, S., Birmaher, B., Chiappetta, L., Brent, D., Kaufman., Bridge, J., & Cully, M. (2000). Screen for child anxiety-related emotional disorders (SCARED): Convergent and divergent validity. Depression and Anxiety, 12(2), 85-91. doi: 10.1002/15206394(2000)12:2<85::aid-da4>3.0.co;2-2

Items of the Screen for Child Anxiety Related Emotional Disorders (SCARED)

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

Example items:

Child version – When I get frightened it is hard to breathe. I don’t like to be away from my family.

Parent version – When my child feels frightened, it is hard for him/her to breathe. My child doesn’t like to be away from his/her family.