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Evidence-based assessment/Screen for Adult Anxiety Related Disorders

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The Screen for Adult Anxiety Related disorders (SCAARED) is an adult anxiety measure that was adapted from the Screen for child anxiety related disorders (SCARED)[1]. This assessment was also created by Boris Birmaher and associates. The SCAARED is a self report questionnaire made up of 44-items[1]. The SCAARED is designed to access for four factors of anxiety. These factors include, somatic/panic/agoraphobia, generalized anxiety, separation anxiety and social anxiety[1]. Each question measures the frequency or intensity of a variety of symptoms or behaviors and the questionnaire takes about ten minutes to complete. An example of a question in the SCAARED is "I am a worrier". Similar to the child version, the questions in the Adult version are multiple choice with three answer choices; "Not true or hardly every true", "Somewhat true or sometimes true", or "Very true or often true".

Although there are many structured interviews and self-report assessment that assess for Anxiety disorders in adults, the SCAARED was developed in order to have a scale that is comparable to the child scale. If a child has anxiety and the clinician uses the SCARED for assessment, when they turn 18, rather than switching to a different scale the SCAARED can be used and the scores would be comparable. This scale is also clinically useful in order to compare adult and child symptoms. This assessment is useful in clinical and research settings as well , not only for diagnosis but also for comparing scores and analyzing progression and development of anxiety disorders[1].

Psychometrics

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Click here for instrument reliability table

Reliability

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Evaluation for norms and reliability for the SCAARED (table from Youngstrom et al., extending Hunsley & Mash, 2008; *indicates new construct or category)
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Norms Adequate Average sized clinical sample, replication study with age/gender matched sample[1].
Internal consistency (Cronbach’s alpha, split half, etc.) Good Alphas between .86 and .97[1]
Interrater reliability Not applicable Designed originally as a self-report scale[1]
Test-retest reliability (stability) Not published This assessment is relatively new, no studies checking test-retest reliability have been published
Repeatability Not published No published studies formally checking repeatability
Click here for instrument validity table

Validity

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Evaluation of validity and utility for the SCAARED (table from Youngstrom et al., unpublished, extended from Hunsley & Mash, 2008; *indicates new construct or category)
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Content validity Good Items are according to specific DSM diagnostic criteria, based on Screen for Child Related Anxiety Disorders(SCARED)[1]
Contruct validity (e.g., predictive, concurrent, convergent, and discriminant validity) Adequate Shows Convergent validity with SCARED,no extensive research published on convergence with other anxiety scales [1]
Discriminative validity Excellent able to discriminate between anxiety and other disorders as well as within anxiety disorders such as generalized versus social anxiety. AUCs between .72 and .84 (p<0.0001)[1]
Validity generalization Adequate Some evidence supports use in more than one demographic group
Treatment sensitivity NA No studies formally testing treatment sensitivity however, SCARED for youth has good treatment sensitivity therefor the same would be expected. [1]
Clinical utility Good Free (public domain), strong psychometrics

Development and history

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Click here for instructions for development and history

Prior to the development of the SCAARED, anxiety and anxiety related disorders in adults were assessed using structured interviews as well as self-reports. Some popular structured interviews for assessing anxiety include the Anxiety Disorders Interview Scales(ADIS) and the Structured Clinical Interview for DSM-IV (SCID-IV).[1] However, structured interviews require extensive training as well as alot of time to complete and are often not reasonable in a clinical setting. Other self-report measures of anxiety do exist, however there was only one that had a comparable youth scale. The Adult Manifest Anxiety Scale has a child version however the SCARED is more widely used and would benefit greatly from having a comparable adult scale.[2] This was the motivation for creating the Adult version. With two valid assessments of anxiety disorders that use the same scale, clinicians and researchers and compare scores as children age in order to track the progress and development of the disorder. The two comparable versions are also helpful in order to compare the presentation of anxiety in adults versus children.[1]

The Screen for Child Related Anxiety Disorders was developed in 1997[2], however the Adults version was not developed until 2017.

Impact

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Although the SCAARED is a relatively new assessment its impact on both clinical settings and research setting will most likely be due to its ability to be used longitudinally and comparatively to the child version (SCARED). In addition to it's practical clinical application, assessing anxiety disorders, the SCAARED can be used if a child has a SCARED score but then age and need a second anxiety assessment as an adult. Using the SCARED and SCAARED together throughout a person's life can give information about the progression of anxiety disorders or symptoms.[1]

Use in other populations

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There is no research to support that the Screen for Adult Anxiety Related Disorders has been tested or used in other populations or translated into other languages. The child version, SCARED has shown good reliability across cultures and languages, so it is expected that the SCAARED would do the same.

Scoring instructions and syntax

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We have syntax in three major languages: R, SPSS, and SAS. All variable names are the same across all three, and all match the CSV shell that we provide as well as the Qualtrics export.

Hand scoring and general instructions

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Click here for hand scoring and general administration instructions

The SCAARED consist of 44 items. The multiple choices for each question are "not true, or hardly ever true" , "somewhat true or sometimes true" , "very true or often true".

"Not true" = 0

"Somewhat true" = 1

"Very true" = 2

Once all items have been scored, scores should be added.

Total Scores ≥ 23 may indicate the presence of an Anxiety Disorder, > 35 is more specific.

Somatic/Panic/ Agoraphobia

score of 5 for items 1, 2, 6, 9, 11, 12, 15, 17, 18, 19, 22, 25, 28, 32, 36, 38, 40

Generalized Anxiety Disorder

score of 12 for items 5, 7, 8, 14, 21, 23, 24, 29, 31, 35, 37, 39, 44

Seperation Anxiety Disorder

score of 3 for items 4, 13, 16, 20, 26, 30, 33

Social Anxiety Disorder

score of 7 for items 3, 10, 27, 34, 41, 42, 43


CSV shell for sharing

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Click here for CSV shell
  • <Paste link to CSV shell here>

Here is a shell data file that you could use in your own research. The variable names in the shell corresponds with the scoring code in the code for all three statistical programs.

Note that our CSV includes several demographic variables, which follow current conventions in most developmental and clinical psychology journals. You may want to modify them, depending on where you are working. Also pay attention to the possibility of "deductive identification" -- if we ask personal information in enough detail, then it may be possible to figure out the identity of a participant based on a combination of variables.

When different research projects and groups use the same variable names and syntax, it makes it easier to share the data and work together on integrative data analyses or "mega" analyses (which are different and better than meta-analysis in that they are combining the raw data, versus working with summary descriptive statistics).

R/SPSS/SAS syntax

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Click here for R code

R code goes here

Click here for SPSS code

SPSS code goes here

Click here for SAS code

SAS code goes here

See also

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Example page

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References

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Click here for references
  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 Angulo, Melina; Rooks, Brian T.; Gill, MaryKay; Goldstein, Tina; Sakolsky, Dara; Goldstein, Benjamin; Monk, Kelly; Hickey, Mary Beth et al.. "Psychometrics of the screen for adult anxiety related disorders (SCAARED)- A new scale for the assessment of DSM-5 anxiety disorders". Psychiatry Research 253: 84–90. doi:10.1016/j.psychres.2017.02.034. https://doi.org/10.1016/j.psychres.2017.02.034. 
  2. ↑ 2.0 2.1 Birmaher, B.; Khetarpal, S.; Brent, D.; Cully, M.; Balach, L.; Kaufman, J.; Neer, S. M. (April 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. ISSN 0890-8567. PMID 9100430. https://www.ncbi.nlm.nih.gov/pubmed/9100430. 
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