Helping Give Away Psychological Science/Measures/SCARED

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The Screen for Child Anxiety Related Disorders, or SCARED, is a screening measure developed by Boris Birmaher (MD), Suneeta Khetarpal (MD), Marlane Cully (M.ED), David Brent (MD), and Sandra Mackenzie (PhD). It takes the intended users, clinicians and psychiatrists, 10 minutes on average to administer. It is a 41 question (originally 38 question), self-report, multiple choice questionnaire designed for children ages 8–18 to screen for anxiety disorders such as panic disorder (significant somatic symptoms), generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and significant school avoidance or refusal. The purpose of SCARED was to create a screening instrument that assesses general anxiety symptoms as well as screen for DSM-IV childhood anxiety disorders. There is a child and adult self-report version of the scale.

Each question measures the frequency or intensity of a variety of symptoms or behaviors and the questionnaire takes about ten minutes to complete. The participant is asked to answer each question with one of three possible answer choices: "Not true or hardly every true", "Somewhat true or sometimes true", or "Very true or often true". Through research, this assessment has been proven to be both valid and reliable. It has been

Question breakdown, scoring and interpretation
The 41 question SCARED tallies points on the assessment by rating answers on a 0-2 scale.
 * 0: Not true or hardly ever true
 * 1: Somewhat true or sometimes true
 * 2: Very true or often true

Question breakdown
Each question is designed to identify symptoms of specific anxiety related disorders. The breakdown is as follows:
 * Some anxiety disorder: questions 1-41
 * Panic disorder or significant somatic symptoms: questions 1, 6, 9, 12, 15, 18, 19, 22, 24, 27, 30, 34, 38
 * Generalized anxiety disorder: questions 5, 7, 14, 21, 23, 28, 33, 35, 37
 * Separation anxiety: questions 4, 8, 13, 16, 20, 35, 29, 31
 * Social anxiety disorder: questions 3, 10, 26, 32, 39, 40, 41
 * Significant school avoidance: questions 2, 11, 17, 36

Use in Other Populations
The SCARED assessment has been translated into Arabic, Chinese, French, German, Italian, Tamil, Thai, Spanish, Czech, and Finnish, and these PDFs can be found here.

A meta-analysis of 25 studies from Belgium, Germany, Italy, the Netherlands, the US, South Africa, and China suggested that

Hand Scoring and General Instructions
On the questionnaire, an answer of "not true or hardly true" is scored as a 0, "somewhat true or sometimes true" is scored as 1, and "very true or often true" is scored as 2. A total score greater or equal to 25 suggests presence of an anxiety disorder.

Parent report

 * Depression and Bipolar Support Alliance: Online screener for anxiety disorders (Parent Report)

Child/youth report

 * Depression and Bipolar Support Alliance: Online screener for anxiety disorders (Child/Youth Report)

Versions
The SCARED was developed to screen for anxiety disorders in children; there is a parent version as well as a youth self-report version.

The original version developed in 1997 was available in 38 items. The SCARED is most commonly used in the 41-item version published in 1999 which was updated with three additional items in the social phobia scale. There is also a 66-item SCARED-Revised (SCARED-R) that includes the panic disorder,  generalized anxiety disorder, social phobia, and  separation anxiety disorder scales.

Use
The SCARED provides an assessment that detects anxiety disorders in children and differentiates between depression and anxiety and specific anxiety and phobia disorders. The assessment should not be used alone to diagnose a child with an anxiety disorder, however research suggest it is a reliable and useful tool when used along with clinical interviewing diagnose anxiety disorders. The SCARED's treatment sensitivity means that it is useful in both clinical and research settings to measure symptoms and presence of anxiety longitudinally, specifically over the course of treatment. It has proved useful in studying the effectiveness of certain treatments of anxiety disorders in children.

In other populations
Studies of the SCARED also indicate good psychometric properties for children and adolescents of different cultures, distinguishing itself from other similar questionnaires. The SCARED has been found to be a reliable assessment tool in several different cultures and translated into many different languages, including, but not limited to, French, German, Italian, Dutch, Spanish, Chinese, Arabic, and Thai.

Limitations
The assessment tool is limited in that it is a self-report measure, which may introduce bias. Another limitation is that, depending on the age and maturity of the child filling out the questionnaire, they may have difficulty recognizing the frequency or severity of both external and internal symptoms. The parent may also be limited in recognizing the internal symptoms of their child's anxiety.

Development and history
Prior to the development of the SCARED, three widely used rating scales for anxiety in children and adolescents included the Revised Children's Manifest Anxiety Scale, the Revised Fear Survey Schedule for Children, and the Somatic State and Trait Anxiety Scale. While these methods were useful in assessing general anxiety symptoms, they were unable to discriminate between anxiety disorders. To address this shortcoming, the SCARED was developed based on DSM-IV classification to screen specifically for general anxiety disorder (GAD), separation anxiety disorder (SAD), panic disorder, social phobia, and school phobia.