Self-report measures in the study of comorbidity in children and adolescents with social phobia: research and clinical utility

We examined differences in self-reported anxiety and depression according to the number and pattern of DSM-IV comorbid diagnoses in 172 children and adolescents (mean age=11.87, S.D.=2.67; range=7-17) with a primary diagnosis of social phobia. Three hypotheses were tested: (1) children with comorbid anxiety disorders would show significantly higher scores than children with social phobia-only on self-report measures, (2) self-report measures would significantly differentiate between children with social phobia and comorbid internalizing versus externalizing disorders, and (3) self-report measures would significantly differentiate children according to the type of anxiety comorbidities present. Multinomial logistic regressions showed that children with three anxiety disorders scored significantly higher than children with one and two diagnoses on two of three self-report measures used. Logistic regressions revealed that children's scores on measures did not differ according to the nature of the comorbid diagnoses (internalizing vs. externalizing). Finally, ROC curves showed that the MASC and the SPAI-C accurately classified children with additional diagnoses of SAD and GAD, respectively. The potential of self-report measures to further our understanding of childhood anxiety comorbidity and the clinical implications of their use to screen for comorbidity are discussed along with suggestions for further study.     

Child and parent reports of childhood anxiety: Differences in coping styles

This study compares children anxious only on parent report (PR) with those anxious on self-report (SR) and self- and parent report (SPR) to examine the reasons for the reporting differences. Sixty-five children aged 7–12 years who met criteria for one or more Axis I anxiety disorders (25% with comorbid nonanxiety diagnoses) completed standardized measures of anxiety, depression, and coping style. Parents completed measures of child psychopathology and adult coping style. Assessing clinicians completed the Global Assessment of Functioning. All parents endorsed anxiety in their children. Based on their responses on standardized self-report measures of anxiety, children were classified as endorsing anxiety (SPR group) or not endorsing anxiety (PR group). Multivariate analysis of variance revealed that children in the SPR group endorsed more depression and employed a greater variety of coping strategies than children in the PR group. The two groups did not differ on parent or clinician measures. These findings suggest that reporting differences may be related to differences in coping styles in anxious children. SPR children may overreport anxiety symptoms due to feelings of decreased self-worth associated with depressive thinking, whereas PR children may be able to distract themselves from their anxieties. The lack of difference in functioning between the two groups suggests that self-report anxiety questionnaire scores are not necessarily indicative of severity. Depression and Anxiety 6:62–69, 1997. © 1997 Wiley-Liss, Inc.     

Impulsivity and internalizing disorders in childhood

Impulsivity has often been related to externalizing disorders, but little is known about how it is related to symptoms of internalizing disorders. This study aims to examine the relationship between impulsivity and depression and anxiety symptoms of depression and anxiety in childhood, and compare it with its relationship with a measure of aggressive behavior, which is present in many externalizing disorders. We administered the Barratt Impulsiveness Scale-11 for children, the Children's Depression Inventory and the Screen for Children's Anxiety Related Emotional Disorders to a case-control sample of 562 children aged between 9 and 13 who were selected from an epidemiological study of anxiety and depression and whose teachers provided information about their proactive and reactive aggression. Impulsivity was related to measures of anxiety, depression and aggressive behavior, and showed higher relationships with measures of internalizing symptoms than with aggression. Motor impulsivity, a component of impulsivity related to inhibition deficits, was the component most related to anxiety and depression. Cognitive impulsivity, on the other hand, was negatively related to anxiety and depression. The relationships between impulsivity and symptoms of internalizing disorders seem to indicate that impulsivity should be taken into account not only in externalizing problems, but also in depression and anxiety in children and adolescents.     

The Screen for Child Anxiety Related Emotional Disorders (SCARED) and traditional childhood anxiety measures

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-report questionnaire that measures symptoms of DSM-IV linked anxiety disorders in children. This article presents two studies that investigated the relationship between the SCARED, on the one hand, and two other widely used anxiety measures for children, namely the Revised Children's Manifest Anxiety Scale (RCMAS) and the Fear Survey Schedule for Children-Revised (FSSC-R), on the other hand. Results indicate that SCARED scores are positively and in a theoretically meaningful way related to RCMAS and FSSC-R scores, and thus provide evidence for the concurrent validity of the SCARED.     

Depression, anxiety, and quality of life in siblings of children with intractable epilepsy

Thirty-seven siblings (aged 6-18) of children with intractable epilepsy were surveyed regarding their anxiety, depression, and quality of life, by both self-report (Revised Children's Manifest Anxiety Scale, RCMAS; Children's Depression Inventory, CDI; and Peds QL) and parental report (Child Behavior Checklist, CBCL). Completed forms were returned by 37 of 58 (64%) eligible families. No sibling had a score in the clinical range on the CDI, and only 2 of 37 (6%) scored in the clinical range on the RCMAS, a proportion similar to the normative population. In contrast, 25% were rated by their parents to have elevated Internalizing Behaviors scores on the CBCL. There was a trend for PedsQL scores to be lower than the normative mean. Comorbid behavior and attention problems in the child with epilepsy and sibling CDI and RCMAS scores correlated significantly with self-reported quality of life. However, other epilepsy, child, and family variables (income, parental education, family function, maternal depression) did not correlate. We conclude that siblings of children with intractable epilepsy are functioning well overall and have a good quality of life.     

Attention deficit disorder and the internalizing dimension in males, ages 9-0 through 11-11

This study assessed the presence of internalizing psychological problems in 9- to 11-year-old males diagnosed with attention deficit hyperactivity disorder (ADHD). The participants' raw scores on the Behavior Assessment System for Children (BASC) Parent Scale, Teacher Rating Scale, and Self-Report of Personality (Reynolds & Kamphaus, 1992) along with the Revised Children's Manifest Anxiety Scale (Reynolds & Richmond, 1985) were compared to the normative sample for each respective measure. The results found that ADHD children presented with significantly (p <.05) higher levels of both anxiety and depression on the BASC and anxiety on the RCMAS when ratings were completed by parents, teachers, and self-report. The results were discussed in terms of the comorbidity of internalizing disorders with ADHD children and need to consider differential behavioral and medical intervention.     

Psychometric evaluation of two new parent-rating scales for measuring anxiety symptoms in young Dutch children

The current study examined the reliability and validity of the Preschool Anxiety Scale (PAS) and the Children's Moods Fears and Worries Questionnaire (CMFWQ) in a Dutch community sample of 275 preschool children aged 2-6 years. The acceptability of PAS and CMFWQ items was good. Preliminary exploratory factor analyses yielded a meaningful five-factor model for the PAS and a three-factor model for the CMFWQ. PAS scales had moderate to high reliability coefficients (alphas between .59 and .86), whereas CMFWQ scales displayed good internal consistency (alphas between .88 and .95). The validity of both measures was supported by a number of findings. First, PAS and CMFWQ scores were substantially correlated. Particularly high correlations were found between the PAS total scale and CMFWQ fear and anxiety problems. Second, PAS and CMFWQ scores were also correlated with CBCL emotionally reactive, anxious/depressed and withdrawn subscales. Third, girls displayed significantly higher scores on the PAS scales than boys, which is in agreement with previous research. Also some age differences were found on the PAS, with older children scoring higher on the social phobia and generalized anxiety disorder subscales than younger children. Finally, CMFWQ and PAS scores discriminated reasonably between children scoring in the normal, subclinical and clinical range of the CBCL subscales. The utility of the PAS and the CMFWQ as a screening instrument for anxiety problems in preschoolers is briefly discussed.     

When the earth stops shaking: earthquake sequelae among children diagnosed for pre-earthquake psychopathology.

OBJECTIVE: To examine risk and protective processes for posttraumatic stress reactions and negative sequelae following the Northridge earthquake (EQ) among youths diagnosed for pre-EQ psychopathology. METHOD: Symptoms of posttraumatic stress disorder (PTSD), depression, general anxiety, and social impairment were evaluated using telephone interviews among 66 children participating in a family-genetic study of childhood-onset depression at the time of the EQ. RESULTS: Significant predictors of PTSD symptoms 1 year after the EQ included perceived stress and resource loss associated with the EQ, a pre-EQ anxiety disorder, and more frequent use of cognitive and avoidance coping strategies. PTSD symptoms were associated with high rates of concurrent general anxiety symptoms, depressive symptoms, and social adjustment problems with friends. The only significant correlation between sibling scores was on measures of sibling reports of objective exposure. CONCLUSIONS: Preexisting anxiety disorders represent a risk factor for postdisaster PTSD reactions. Postdisaster services need to attend to the needs of these youths as well as those of youths experiencing high levels of subjective stress, resource loss, and/or high exposure. That children within families show significant variation in postdisaster reactions underscores the need for attention to individual child characteristics and unshared environmental attributes.     

Self-esteem in children after traumatic brain injury: an exploratory study

Children with a traumatic brain injury (TBI) often have difficulties in adjusting to their injury and altered abilities, and may be at risk of low self-esteem and loss of confidence. However, few studies have examined self-esteem in this client group. The current study measured the self-esteem of a group of children who were, on average, two years post-TBI and compared this to their performance on other psychometric measures. Participants were 96 children with TBI and 31 peer controls, their parents and teachers. Self-esteem was measured using the Coopersmith Self-esteem Inventory (CSEI). CSEI scores were compared with performance on Wechsler Intelligence Scales (WISC-III), Hospital Anxiety and Depression Scale (HADS); Children's Memory Scale (CMS), Vineland Adaptive Behaviour Scales (VABS) and Parental Stress Index (PSI). Self-esteem was highly correlated with IQ; HADS anxiety and depression; and parental stress (p< 0.001). Children with TBI had significantly lower self-esteem than controls and population norms (p=0.015). Many children with TBI demonstrate low self-esteem and this is closely linked with anxiety and depression. This may hamper academic performance and could lead to further psychosocial problems. It is recommended that self-esteem is routinely assessed after brain injury and rehabilitation strategies implemented to promote a sense of self-worth.     

A Brief Depression and Anxiety Rating Scale for Sexual Violence Victims

ObjectiveThis study aimed to develop a brief self-report measure of depressive and anxiety symptoms in victims of sexual violence. Methods The sample, which consisted of 215 victims and 255 healthy controls, was recruited between December 2016 and November 2018 from eight Sunflower Centers. Eligible items were selected from existing scales of depression (CES-DC and CES-D) and anxiety (SAI-C and BAI) symptoms by item-total correlation coefficients and item response theory (IRT) analysis. Internal consistency coefficients were computed and the receiver operating characteristics curve was inspected to assess the validity of the brief scale and determine optimal cutoff scores. Results The brief scales showed high internal consistency across all age groups. The optimal cutoff score of brief depression scale was 1.5 for children, 2.5 for adolescents, and 2.5 for the adults. That of brief anxiety scale was 8.5, 6.5, and 3.5, respectively. Conclusion The results underscore the need for age-appropriate screening measures of depressive and anxiety symptoms in victims of sexual violence.     

Cognitive impairment in multiple sclerosis does not affect reliability and validity of self-report health measures

Patient self-report health measures have received increasing recognition as supplementary outcome parameters in multiple sclerosis (MS). Given the high prevalence of cognitive problems in this population, reliability and validity of self-report instruments in patient groups with cognitive impairment is essential, especially when using such scales longitudinally. A sample of 80 MS patients with cognitive dysfunction according to Symbol Digit Modalities Test (SDMT) score and 107 unimpaired patients were included in the analyses. Data was available from the Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS), the Hospital Anxiety and Depression Scale (HADS), clinical rating scores [Expanded Disability Status Scale (EDSS) and FS (Functional Status) scales, CAMBS (Cambridge MS Basic Score)] and objective tests of upper and lower limb function [Timed 8 Meter Walk (T8) and Nine Hole Peg Test (9HPT)). Both self-report questionnaires showed satisfactory internal consistencies and retest reliability. Pattern and magnitude of correlations with other health status measures supported the validity of both instruments. However, there was a marked discrepancy between subjective and objective measures of cognitive function. Cognitively impaired patients furthermore showed significantly higher depression and anxiety as well as lower quality of life (QoL). The report provides evidence that QoL and affective symptomatology can be reliably assessed in MS patients with cognitive dysfunction. The common pattern of poor correlation between self-rated and objective cognitive function thus appears to be a result of the patients' (adaptive or maladaptive) coping mechanisms rather than being due to inaccurate measurement.     

Assessment of Anxiety and Depression in Adolescents with Mental Retardation

This report examines the concurrent validity of different informant and self-report assessment instruments of psychopathology, both general and specific for anxiety and/or depression, in referred mentally retarded adolescents with a depressive and anxiety disorders, according to DSM IV criteria. A consecutive, unselected sample of 50 mildly and moderate mentally retarded adolescents (29 males and 21 females, aged 11.8 to 18 years, mean age 15.1) were assessed using standardized assessment techniques: Psychopathology Instrument for Mentally Retarded Adults (PIMRA) (informant version) (total score, affective and anxiety subscales), Child Behavior Checklist (CBCL) (informant version) (total score, internalizing and externalizing scores, anxiety-depression scale), Zung Self-Rating Depression Scale and Zung Self-Rating Anxiety Scale. Patterns of correlation among measures were calculated. PIMRA and CBCL total scores were closely intercorrelated. Internalizing and externalizing scores of CBCL were not intercorrelated, but they both correlated with CBCL and PIMRA total scores. Anxiety measures were positively correlated; they correlated with PIMRA and CBCL total scores, as well as with the internalizing score of CBCL. Depression measures were not correlated; their correlation with more general measures of psychopathology was weak. Clinical implications of these findings are discussed.     

Association of Reactive–Proactive Aggression and Anxiety Sensitivity with Internalizing and Externalizing Symptoms in Children with Attention-Deficit/Hyperactivity Disorder

This study evaluates the associations among the symptoms of anxiety, depression, and disruptive behavioral disorders (DBD) in the context of their relationships with reactive–proactive aggression and anxiety sensitivity in children with attention-deficit/hyperactivity disorder (ADHD). The sample consisted of 342 treatment-naive children with ADHD. The severity of ADHD and DBD symptoms were assessed via parent- and teacher-rated inventories. Anxiety sensitivity, reactive–proactive aggression and severity of anxiety and depression symptoms of children were evaluated by self-report inventories. According to structural equation modeling, depression and anxiety scores had a relation with the DBD scores through reactive–proactive aggression. Results also showed a negative relation of the total scores of anxiety sensitivity on DBD scores, while conduct disorder scores had a positive relation with anxiety scores. This study suggests that examining the relations of reactive–proactive aggression and anxiety sensitivity with internalizing and externalizing disorders could be useful for understanding the link among these disorders in ADHD.     

"Danger is lurking everywhere". the relation between anxiety and threat perception abnormalities in normal children

The present study examined the relation between anxiety and depression and threat perception abnormalities. Children were exposed to stories describing social situations. Some of the stories were ambiguous (i.e., these stories contained information that could be interpreted as threatening) whereas other stories were non-threatening (i.e., these stories contained no obvious trace of threat). From children's responses to the stories, several threat perception indices were derived. Children's level of anxiety and depression were assessed by means of self-report questionnaires. Results indicated that high levels of anxiety were accompanied by a high frequency of threat perception, high ratings of threat, a high frequency of threatening interpretations, high levels of negative feelings and cognitions, and an early detection of threat. Interestingly, significant associations between anxiety and threat perception abnormalities were not only observed in response to ambiguous stories but also in relation to non-threatening scenarios. Furthermore, depression was also connected with threat perception distortions. Even when controlling for anxiety levels, depression remained significantly related to threat frequency, threat ratings, and threat thresholds.     

Anxiety and depression in children with epilepsy and their mothers

OBJECTIVE: Children with epilepsy have high rates of depression and anxiety. The majority of studies concentrate on the children with epilepsy, but the emotional impact of epilepsy on family members is of clinical concern. In this cross-sectional study we aimed to examine the association between epilepsy in childhood and adolescence, and anxiety and depression in these patients and their mothers. METHODS: We studied 35 children and adolescents with seizures (age range, 7-19 years), 35 gender-matched healthy controls (age range, 8-17) who did not have any chronic medical illness, and mothers of these individuals (n=70) in a cross-sectional analysis. We administered the Kovac Child Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIc) to the children. We administered the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) to the mothers of these children. Pearson correlations were used to analyze dependence between variables, and Student's t test was used to compare mean values between test scores. RESULTS: Patients with epilepsy had higher CDI scores (mean+/-SD, 12.48+/-6.35) than controls (9.31+/-5.11) (P<0.05), whereas the STAIc scores did not differ between cases (34.03+/-8.29) and controls (35.20+/-6.23) (P<0.05). Mothers of children with epilepsy did not have more depression or anxiety symptoms than mothers of children without epilepsy as measured by BDI and STAI scores (P>0.05). There was no correlation between mothers' scores and patients' or controls' scores. CONCLUSIONS: These results support findings from previous studies that children and adolescents with epilepsy have a higher frequency of depressive but not anxiety symptoms than the general population of healthy children and that this is independent of their mothers' symptoms.     

Interrater reliability and clinical efficacy of Children's Yale-Brown Obsessive-Compulsive Scale in an outpatient setting

OBJECTIVE: To evaluate the interrater reliability of the Turkish version of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and to measure the clinical efficacy using a clinician-rated impression scale in a clinical outpatient setting. METHOD: Data were collected from 19 nonmedicated children and adolescents (6 girls, 13 boys, mean age 14 +/- 2.25 years) with obsessive-compulsive disorder (OCD). Interrater reliability was assessed by 3 raters through videotape recordings of evaluation. Correlational analyses were maintained by comparing CY-BOCS scores to self-ratings of Children's Depression Inventory (depression), 20-item Leyton Obsessional Inventory-Child Version (obsessive-compulsive symptoms), and Child Behavior Checklist (parent ratings of behavioral problems). The Clinical Global Impression for OCD was administered to measure the clinical efficacy of CY-BOCS. RESULTS: Internal consistency was .77 for the total 10 items. The interrater reliabilities, defined as the intraclass correlation for the compulsion subscale, the obsession subscale, and the CY-BOCS total scores were .85, .94, and .89, respectively. Although the sample size was small, CY-BOCS total score was correlated with the Clinical Global Impression score (P < .01) and showed a significantly higher correlation with Leyton Obsessional Inventory-Child Version scores when compared with Children's Depression Inventory and Child Behavior Checklist scores. CONCLUSION: Our results indicate that the Turkish version of CY-BOCS yielded good interrater reliability and was significantly correlated with a clinician-rated global impression scale. Although the small sample size hinders a conclusion, CY-BOCS showed significant results regarding validity measures. Therefore, our results support that CY-BOCS has the potential to fulfill the need in clinical research settings.     

Structural evidence for involvement of a left amygdala-orbitofrontal network in subclinical anxiety

Functional neuroimaging implicates hyperactivity of amygdala-orbitofrontal circuitry as a common neurobiological mechanism underlying the development of anxiety. Less is known about anxiety-related structural differences in this network. In this study, a sample of healthy adults with no history of anxiety disorders completed a 3T MRI scan and self-report mood inventories. Post-processing quantitative MRI image analysis included segmentation and volume estimation of subcortical structures, which were regressed on anxiety inventory scores, with depression scores used to establish discriminant validity. We then used a quantitative vertex-based post-processing method to correlate (1) anxiety scores and (2) left amygdala volumes with cortical thickness across the whole cortical mantle. Left amygdala volumes predicted anxiety, with decreased amygdala volume associated with higher anxiety on both state and trait anxiety measures. A negative correlation between left amygdala volume and cortical thickness overlapped with a positive correlation between anxiety and cortical thickness in left lateral orbitofrontal cortex. These results suggest a structural anxiety network that corresponds with a large body of evidence from functional neuroimaging. Such findings raise the possibility that structural abnormalities may result in a greater vulnerability to anxiety or conversely that elevated anxiety symptoms may result in focal structural changes.     

Symptom correspondence between clinicians and patients on the Yale–Brown Obsessive Compulsive Scale

The present study examined concordance between the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) and its self-report version (Y-BOCS-SR), as well as theoretically derived moderators. Sixty-seven adults (ages 18–67) with obsessive–compulsive disorder (OCD) were administered the Y-BOCS prior to completing self-report measures. The Y-BOCS-SR generated lower scores relative to the clinician-administered Y-BOCS (5.3 points lower). Strong correspondence was shown between the Y-BOCS and Y-BOCS-SR; however, many items exhibited fair to moderate agreement, particularly the resistance and control against obsessions/compulsions items. Depression significantly moderated correspondence such that Y-BOCS-SR scores significantly predicted Y-BOCS scores in the presence of low and average depression levels in our sample, but not for patients with high levels of depression relative to the rest of our sample; gender, generalized anxiety and obsessionality did not significantly impact agreement. Synthesizing the present data, the Y-BOCS-SR demonstrates modest agreement with the Y-BOCS and may underestimate clinical severity especially for those with high levels of depression.     

Psychometric evaluation of the Children's Yale-Brown Obsessive-Compulsive Scale

This study evaluated the psychometric properties of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). A total of 61 children and adolescents, aged 4-18 years, who were diagnosed with obsessive-compulsive disorder (OCD) participated. Thirty-seven of these children also participated in a second CY-BOCS administration by the same rater an average of 41 days later. Good internal consistency and test-retest reliability were found for the CY-BOCS Obsession and Compulsion Severity Scores and the Total Score. CY-BOCS scores demonstrated strong correlations with clinician-rated measures of impairment, obsessions, and compulsions. In addition, CY-BOCS scores were moderately related to measures of depression, aggressive behavior, and symptoms of attention deficit hyperactivity disorder, but were not significantly related to clinician ratings of tics or self-reports of general anxiety. Findings suggest that the CY-BOCS is a reliable and valid instrument for the assessment of childhood obsessions and compulsions.     

Psychometric properties and diagnostic ability of the separation anxiety scale for children (SASC)

This research describes the psychometric properties of a new child self-report measure, the separation anxiety scale for children (SASC), which assesses the frequency of symptoms of separation anxiety in children from 8 to 11. The factor solution with a sample of 1,201 children from 8 to 11, isolated three factors, discomfort from separation, worry about separation, and calm at separation, tested by confirmatory factor analysis, which accounted for 32.80% of the total variance. Results indicated that the SASC has a high internal consistency (α = 0.83). The results revealed a high test-retest reliability of the instrument, and a high number of correctly diagnosed cases. The correlation of scores with other anxiety measures shows that the variable most associated with separation anxiety is trait–anxiety.