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evaluations of treatments for child anxiety are based on children who meet criteria for anxiety disorders as their principal disorder. In some cases, however, it may be more important to determine which disorder appears to be the underlying or causal problem. For example, a child suffering depression, loneliness and victimisation because of their social anxiety may respond best if the social anxiety is treated first, regardless of whether it is the primary condition. In some cases, a particular problem may be expected to interfere with treatment response and may therefore require initial attention, even if it is not the principal disorder. For example, a child whose anxiety appears to be most interfering but whose additional depression results in low motivation may need treatment of the depression and motivation before they will be able to engage in treatment for the anxiety. Questionnaire assessment of child anxiety The severity of anxiety or extent of anxiety symptomatology can be measured using several questionnaires. Most have demonstrated good psychometric properties from around age 8 or 9 years and can be used up to middle or late adolescence. From middle adolescence, adult measures of anxiety are usually suitable. Very few measures have been developed for younger children. A few questionnaires contain subscales that each tap diagnostic-like constructs such as separation anxiety, social anxiety or generalised anxiety. Most of these questionnaires have parallel versions for the parent and child. These include: • Spence Children’s Anxiety Scale (SCAS) (free of charge and available in several languages) • Screen for Anxiety and Related Disorders (SCARED) • Multidimensional Anxiety Scale for Children (MASC). A similar measure has recently been developed for preschool-aged children, to be completed by their parents only – the Preschool Anxiety Scale, Revised (PAS-R) (free of charge and available in several languages). Anxiety disorders F.1 8 IACAPAP Textbook of Child and Adolescent Mental Health Several older measures aim to assess the overall degree of anxiousness more broadly. These include: • Revised Children’s Manifest Anxiety Scale (RCMAS) • State Trait Anxiety Inventory for Children (STAIC) • Beck Anxiety Inventory for Youth. A similar measure assessing internalising symptomatology completed by parents has also been developed for children at preschool age – Children’s Moods, Fears and Worries (Bayer et al, 2006). In some circumstances, more specific and detailed assessment of a particular form of anxiety may be required. In these cases, a few measures tap into specific aspects of anxiety including: • Fear Survey Schedule for Children Revised (FSSCR) • Social Phobia and Anxiety Inventory for Children (SPAIC) • Social Anxiety Scale for Children - Revised (SASC-R) • Children’s Anxiety Sensitivity Index (CASI) (Silverman et al, 1991) Finally, a few measures from our own centre may be of value since they tap relevant aspects related to anxiety disorders. The Children’s Automatic Thoughts Scale (CATS) is designed to assess specific beliefs experienced by children and adolescents with a variety of disorders. Two of the subscales are especially relevant to anxiety: beliefs related to social threat and physical threat. The remaining subscales assess beliefs related to personal failure and hostility. The School Anxiety Scale -Teacher Report (SAS-TR) provides a measure of children’s anxiety that can be completed by the classroom teacher. This measure is an additional source of information that can flesh out a broader clinical picture of the anxious child. Finally, the Children’s Anxiety Life Interference Scale (CALIS) has two parallel measures (one reported by the child and the other by parents) that assess the extent to which the child’s anxiety impacts on the child’s and family’s life. RISK AND MAINTAINING FACTORS Family transmission Anxiety runs in families. First degree relatives of people with anxiety disorders are at increased risk to also have anxiety as well as mood disorders. The same is true more specifically for anxiety in children and adolescents. Anxious children are considerably more likely to have parents with anxiety disorders and adults with anxiety disorders are more likely to have anxious children (Rapee et al, 2009). A similar relationship occurs more generally for temperament that is related to anxiety (see below). Adults with anxiety disorders are more likely to have children who are highly inhibited and inhibited children are more likely to have parents with anxiety and mood disorders (Rosenbaum et al, 1993). One important finding is that family transmission of anxiety seems to show some specificity. In other words, several studies have shown that people with a particular anxiety disorder (e.g., social phobia) are more likely to have first degree relatives with that same disorder (social phobia) than with other anxiety disorders. This is different from research on genetic factors that has not shown specificity (see below). Of course, family transmission can reflect both genetic and environmental influences, so it is tempting to speculate that genetic transmission confers a broad, general risk, while family environment may shape that risk into specific manifestations. Click on the picture to view the Centre for Emotional Health’s website from where the CATS, SAS-TR, and CALIS, as well as the PASR can be downloaded free of
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