Evidence based assessment/Generalized anxiety disorder (assessment portfolio)

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Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Please refer to the full text of the Wikiversity medical disclaimer.

What is a "portfolio"?[edit]

  • For background information on what assessment portfolios are, click the link in the heading above.

Preparation phase[edit]

Diagnostic criteria for generalized anxiety disorder[edit]

Click here for ICD-10 Criteria

ICD-10 Diagnostic Criteria[1]

  • A condition marked by excessive worry and feelings of fear, dread, and uneasiness that last six months or longer. Other symptoms of gad include being restless, being tired or irritable, muscle tension, not being able to concentrate or sleep well, shortness of breath, fast heartbeat, sweating, and dizziness.
  • An anxiety disorder characterized by excessive and difficult-to-control worry about a number of life situations. The worry is accompanied by restlessness, fatigue, inability to concentrate, irritability, muscle tension, and/or sleep disturbance and lasts for at least 6 months.
  • An anxiety disorder characterized by free-floating, persistent, and excessive worry for at least six months.
  • Apprehension of danger and dread accompanied by restlessness, tension, tachycardia, and dyspnea unattached to a clearly identifiable stimulus.
  • Apprehension or fear of impending actual or imagined danger, vulnerability, or uncertainty.
  • Fear and anxiety are part of life. You may feel anxious before you take a test or walk down a dark street. This kind of anxiety is useful - it can make you more alert or careful. It usually ends soon after you are out of the situation that caused it. But for millions of people in the United States, the anxiety does not go away, and gets worse over time. They may have chest pains or nightmares. They may even be afraid to leave home. These people have anxiety disorders
  • Feeling of distress or apprehension whose source is unknown
  • Feeling or emotion of dread, apprehension, and impending disaster but not disabling as with anxiety disorders.
  • Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.
  • Unpleasant, but not necessarily pathological, emotional state resulting from an unfounded or irrational perception of danger; compare with fear and clinical anxiety.
  • Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with threat

Changes in DSM-5

  • The diagnostic criteria for generalized anxiety disorder changed slightly from DSM-IV to DSM-5. Summaries are available here and here.

Base rates of GAD in different clinical settings[edit]

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of GAD that they are likely to see in their clinical practice.

  • To see prevalence rates across multiple disorders, click here.
Demography Base Rate Setting Diagnostic Method Best Recommended For
Adults and adolescences in all of U.S.A.
  • 0.9% (age 13-17)
  • 2.9% (age 18-64)
  • 1.2% (age >= 65)
  • 2.0% (age >=13)
NCS-R and NCS-R (age > = 13)

(2012)[2]

Fully-structured CIDI Version 3.0
Psychiatric outpatients
  • 21%
Individuals seeking treatment in a Psychiatric Outpatient Clinic (age range not reported)

(2014)[3]

Structured Clinical Interview for DSM-IV (SCID)
Caucasian youth
  • 0.39% (parent report)
  • 0.38% (child report)
Children seeking treatment in a Child & Adolescent Anxiety Diagnostic Clinic (age 7 – 18 years old)

(2011)[4]

ADIS-C for DSM-IV

Spence Children's Anxiety Scale (SCAS)

Caucasian, African American, Asian American, and Hispanic population
  • 4.1% (female)
  • 2.1% (male)
CPES (age >= 18, data merged from three representative national database)

(2011)[5]

World Mental Health Survey Initiative Version of the World Health Organization Composite International Interview (WMH-CIDI)
Pennsylvania
  • 10%
Metropolitan Community Sample, all individuals with eating disorders (ages 13 – 65)

(2014)[6]

Structured Clinical Interview for DSM-IV (SCID)
Adolescents in all of U.S.A.
  • 2.2%
NCS-A (ages 3–18 in the continental U.S)

(2011)[7]

World Health Organization Composite International Diagnostic Interview (WHO-CIDI)
North Carolina
  • 1.4%
Rural community sample African American and White youth (ages 13-16)

(2002)[8]

The Child and Adolescent Psychiatric Assessment (CAPA)
Texas
  • 0.4%
Metropolitan Community Sample (ages 11-17)

(2007)[9]

Diagnostic Interview Schedule for Children, Version IV (DISC-IV)
Midwestern Urban
  • 1%
Incarcerated adolescents (ages 10-18)[10]

(2002)

Diagnostic Interview Schedule for Children, Version IV (DISC-IV)
The southern Appalachian mountain region of North Carolina
  • 1.67%
Great Smoky Mountain (ages 9-12)

(1996)[11]

DSM-III-R, DSM-IV and CAPA
New Jersey
  • 3.7%
Non-referred Adolescent Population (ages 9-17)

(1990)[12]

DSM-III & Beck Depression Inventory (BDI)
Non-institutionalized general US population Women:
  • 14.8% same-sex
  • 22.5% bisexual

Men:

  • 16.9% same-sex
  • 11.5% bisexual
LGTBQ sample (ages 20-65)[13] (2013) The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV)
Non-institutionalized general US population
  • White 8.6%
  • African Americans 4.9%
  • Hispanic Americans 5.8%
  • Asian Americans 2.4%
Cross-ethnic American population (ages 18+)[14] (2018) World Mental Health Survey Initiative Version of the World Health Organization Composite International Interview (WMH-CIDI)
Outpatient clinic (DAU) 5%[15]
Outpatient clinic (SDI) 10%[15]
General Population 2.2%[16]

Search terms: [General Anxiety Disorder] AND [youth OR adolescents OR pediatric] AND [prevalence OR incidence] in GoogleScholar and PsycINFO

Prediction phase[edit]

Psychometric properties of screening instruments for GAD[edit]

The following section contains a list of screening and diagnostic instruments for generalized anxiety disorder. The section includes administration information, psychometric data, and PDFs or links to the screenings.

  • Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
  • For a list of more broadly reaching screening instruments, click here.
Screening measures for GAD
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended PDF
Penn State Worry Questionnaire (PSWQ)[17] Questionnaire (Child) 6-18 4 minutes NA[17] G[17] G[17] G[17] [17]
Light green check.svg

PDFs of the PSWQ

Screen for Child Anxiety Related Emotional Disorder (SCARED) Questionnaire (Child, Parent) 8-19 9 or 16 minutes

PDFs of SCARED

State/Trait Anxiety Inventory for Children (STAIC) Questionnaire (Child, Parent) 6-18 5 or 10 minutes NA[17] G[17] G[17] G[17]
Revised Children’s Anxiety and Depression Scale (RCADS) Questionnaire (Child) 6-18 12 minutes G[18] G[19] G[18]

PDFs for RCADS

Subscales

Translations

User Guide

Spence Children’s Anxiety Scale (SCAS) Questionnaire (Child, Parent) 7-19 11 minutes NA[17] A[17] E[17] E[17] SCAS homepage

PDF

GAD-7 Scale Self report 5 minutes Intraclass correlation 0.83[20] GAD-7 homepage

PDF (english)

PDF (spanish)

Kessler Psychological Stress Scale (K10 and K6 Scales) Self or interview administered Available in many languages
Worry and Anxiety Questionnaire (WAQ) Self report 10 minutes NA[17] A[17] A[17] G[17] [17]
Light green check.svg
WAQ homepage

PDF

Brown Assessment of Beliefs Scale (BABS) G[17] A[17] G[17] G[17]
Light green check.svg
[17]
Generalized Anxiety Disorder Questionnaire for DSM IV (GAD-Q-IV) Self-report Less than 10 minutes NA[17] A[17] A[17] G[17]

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Likelihood ratios and AUCs of screening instruments for GAD[edit]

  • For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
Screening Measure (Primary Reference) Format (Reporter) Area Under Curve (AUC) LR+ (Score) LR- (Score) Citation Clinical Generalizability
Penn State Worry Questionnaire (PSWQ)[21] Questionnaire (Child) 0.74

(N=164)

1.8 (65+) 0.5 (< 65) Fresco, D.M., Mennin, D.S., Heimberg, R.G., Turk, C.L. (2003)[22] Generalized Anxiety Disorder vs. social anxiety disorder, adults presenting to specialty anxiety clinic
Screen for Child Anxiety Related Disorders (SCARED)[23] Questionnaire (Child, Parent) .70

(N=243)

5.0 (+32) .04 (Birmaher et al., 1997)[23] High: Pure anxiety disorder versus non-anxiety psychiatric disorder, excluding children with disruptive disorder and depression
0.911 (First screen)

(N= 923)

2.81 (4+; FS) 0.15 (4-; FS) Hale III, et al., 2014[24]
STAIC[25] Questionnaire (Child, Parent) -- (N=70) 2 (+69) .79 DLR: (Hodges, 1990) STAIC does well in discriminating between children and adolescents with anxiety disorders and youth without a disorder and moderately well in measuring treatment response and discriminating youth with anxiety disorders from those with externalizing disorders[26]
RCADS[27] Questionnaire (Child) -- (N=513) 9.8 0.24 DLR: (Chorpita, Moffitt & Gray, 2005)[28] High: Several studies demonstrate support for the RCADS in non-referred samples of youth
SCAS[29] Questionnaire (Child, Parent) 0.83

(N=654)

-- -- (Nauta et al., under review)
Generalized Anxiety Disorder Scale (GADS)[30] 0.88

(N = 438)

6.3 (5+) .41 (5-) Wild et al., 2014 Elderly persons (ages 58–82) from general population in German

Note: “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation[31].

Search terms: [General Anxiety Disorder] AND [children OR adolescents OR pediatric] AND [sensitivity OR specificity] in GoogleScholar and PsycINFO

Interpreting depression screening measure scores[edit]

  • For information on interpreting screening measure scores, click here.

Prescription phase[edit]

Gold standard diagnostic interviews[edit]

  • For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Recommended diagnostic instruments for GAD[edit]

Diagnostic instruments for GAD
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Anxiety Disorders Interview Schedule for Children (ADIS-C)[32] Child Varies E[32] E[32] G to E[32] N/A Purchase
Anxiety Disorders Interview Schedule for Children (ADIS-P)[32] Parent Varies E[32] E[32] E[32] N/A Purchase
Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV)

*not free

Adult Varies A[17] NA[17] A[17] A[17] [17]
Light green check.svg
Structured Clinical Interview for DSM-IV-TR for Axis I Disorders (SCID-I/P)

*not free

Varies A[17] NA[17] A[17] A[17] Website and purchase
Structured Clinical Interview for DSM-IV-TR for Axis II Disorders (SCID-II)

*not free

Varies E[17] NA[17] U[17] U[17] Website and purchase
Structured Clinical Interview for DSM-IV (SCID-IV)

*not free

Varies A[17] A[17] E[17] E[17] Website and purchase

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Severity interviews for GAD[edit]

Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Children's Depression Rating Scale - Revised (CDRS-R) Structured Interview[33] 6-12 15-20 minutes G A G G X

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Process phase[edit]

The following section contains a list of process and outcome measures for generalized anxiety disorder. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

Process measures[edit]

Outcome and severity measures[edit]

  • This table includes clinically significant benchmarks for (insert portfolio name here) specific outcome measures
  • Information on how to interpret this table can be found here.
  • Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
  • For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Clinically significant change benchmarks with common instruments for GAD
Measure Cut-off scores Critical Change
(unstandardized scores)
Benchmarks Based on Published Norms
A B C 95% 90% SEdifference
GAD-7 -1 1.3 0.5 0.6 0.5 0.3
PSWQ 51 73 59 9 8 4.8
SCARED 9.9 18.1 15.3 8.9 7.5 4.5
STAIC 0.9 30.1 18.2 18.9 15.9 9.6
RCADS -1.1 12.7 6.6 7.3 6.1 3.7
SCAS -0.7 15.1 5.4 6.2 5.2 3.2

Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.

Search terms: [General Anxiety Disorder] AND [children OR adolescents OR pediatric] AND [clinical significance OR outcomes] in GoogleScholar and PsycINFO

Treatment[edit]

Click here for treatment information

Individuals suffering from GAD tend to be high users of outpatient medical care. When treating GAD, physicians should first determine whether pharmacotherapy, psychotherapy, or a combination of the two treatments would be most beneficial to the patient. Literature suggests that treatment of GAD frequently consists of a combination of psychotherapy and pharmacotherapy. Although these therapies have the potential to be effective individually, previous work demonstrates that when combined the degree of clinically significant change increases significantly. Recent studies (e.g., Gorman, 2003[34]; Walkup et al., 2008[35]) have provided evidence to support this claim with the most efficacious medication and behavioral interventions listed below.

  1. Medication Interventions
    1. Sertraline (Zoloft) has been shown to reduce experiences and effects of GAD above and beyond that of placebo conditions.
    2. Pregabalin. The mean baseline-to-endpoint decreases in total Hamilton anxiety scale score in the patients given 150 mg/day of pregabalin (–9.2) was significantly greater than the decrease in those given placebo (–6.8)[36].
    3. Paroxetine. Remission was achieved by 30% of patients in the 20-mg paroxetine groups compared with 20% given placebo. For all three domains of the Sheehan Disability Scale, significantly greater improvement was seen with paroxetine than placebo[37].
  2. Behavioral interventions
    1. Cognitive behavioral therapy. Fourteen 60-minute sessions, which include CBT in anxiety-management skills, followed by behavioral exposure to anxiety-provoking situations have been shown to be effective in treating GAD. A review of studies by Fisher and Durham (1999)[38] revealed significant recovery rates at a 6 month follow up after CBT.
    2. Exposure therapy and modeling therapy. One meta-analysis found that virtual reality exposure therapy for anxiety disorders had a large effect size (Cohen's d=1.11) compared to controls.[39]
    3. Mindfulness meditation. New treatment options such as mindfulness meditation-based stress reduction interventions have also shown to reduce symptoms over the long-term.[40]
  3. Combination treatment
    1. Previous research suggests that combination therapy that includes components of psychotherapy and pharmacotherapy are the most efficacious in treating GAD. In a study comparing the efficacies GAD treatments, Walkup and colleagues demonstrated a 21-25% improvement of combination therapy over cognitive behavioral therapy or sertraline alone during short-term treatment. These findings suggest that among effective treatments, combination therapy has the potential to provide the best chance for a positive outcome. See Gorman, 2003[34]; Walkup et al., 2008[35].

External Resources[edit]

  1. ICD-10 diagnostic criteria
  2. Find-a-Therapist
    • This is a curated list of find-a-therapist websites where you can find a provider
  3. NIMH entry about anxiety disorders
  4. OMIM (Online Mendelian Inheritance in Man)
  5. eMedicine entry about anxiety disorders
  6. Society of Clinical Child and Adolescent Psychology
  7. Effective Child Therapy information on Fear, Worry, & Anxiety
    • Effective Child Therapy is website sponsored by Division 53 of the American Psychological Association (APA), or The Society of Clinical Child and Adolescent Psychology (SCCAP), in collaboration with the Association for Behavioral and Cognitive Therapies (ABCT). Use for information on symptoms and available treatments.
  8. Links to SCARED Child, Parent, and Adult + Translations

References[edit]

Click here for references
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  2. Kessler, RC; Petukhova, M; Sampson, NA; Zaslavsky, AM; Wittchen H, -U (September 2012). "Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States.". International journal of methods in psychiatric research 21 (3): 169-84. PMID 22865617. 
  3. Zimmerman, M; Rothschild, L; Chelminski, I (October 2005). "The prevalence of DSM-IV personality disorders in psychiatric outpatients.". The American journal of psychiatry 162 (10): 1911-8. PMID 16199838. 
  4. Brown-Jacobsen, AM; Wallace, DP; Whiteside, SP (September 2011). "Multimethod, multi-informant agreement, and positive predictive value in the identification of child anxiety disorders using the SCAS and ADIS-C.". Assessment 18 (3): 382-92. PMID 20644080. 
  5. McLean, CP; Asnaani, A; Litz, BT; Hofmann, SG (August 2011). "Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness.". Journal of psychiatric research 45 (8): 1027-35. PMID 21439576. 
  6. Kaye, WH; Bulik, CM; Thornton, L; Barbarich, N; Masters, K (December 2004). "Comorbidity of anxiety disorders with anorexia and bulimia nervosa.". The American journal of psychiatry 161 (12): 2215-21. PMID 15569892. 
  7. Merikangas, KR; He, JP; Burstein, M; Swanson, SA; Avenevoli, S; Cui, L; Benjet, C; Georgiades, K et al. (October 2010). "Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A).". Journal of the American Academy of Child and Adolescent Psychiatry 49 (10): 980-9. PMID 20855043. 
  8. Angold, Adrian; Erkanli, Alaattin; Farmer, Elizabeth M. Z.; Fairbank, John A.; Burns, Barbara J.; Keeler, Gordon; Costello, E. Jane (October 2002). "Psychiatric disorder, impairment, and service use in rural African American and white youth". Archives of General Psychiatry 59 (10): 893–901. ISSN 0003-990X. PMID 12365876. https://www.ncbi.nlm.nih.gov/pubmed/12365876. 
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  10. ABRAM, KAREN M.; CHOE, JEANNE Y.; WASHBURN, JASON J.; TEPLIN, LINDA A.; KING, DEVON C.; DULCAN, MINA K.. "Suicidal Ideation and Behaviors Among Youths in Juvenile Detention". Journal of the American Academy of Child & Adolescent Psychiatry 47 (3): 291–300. doi:10.1097/chi.0b013e318160b3ce. http://linkinghub.elsevier.com/retrieve/pii/S0890856709623121. 
  11. Costello, EJ; Angold, A; Burns, BJ; Stangl, DK; Tweed, DL; Erkanli, A; Worthman, CM (December 1996). "The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders.". Archives of general psychiatry 53 (12): 1129-36. PMID 8956679. 
  12. Whitaker, A; Johnson, J; Shaffer, D; Rapoport, JL; Kalikow, K; Walsh, BT; Davies, M; Braiman, S et al. (May 1990). "Uncommon troubles in young people: prevalence estimates of selected psychiatric disorders in a nonreferred adolescent population.". Archives of general psychiatry 47 (5): 487-96. PMID 2331210. 
  13. Bostwick, Wendy B.; Boyd, Carol J.; Hughes, Tonda L.; McCabe, Sean Esteban (2010-3). "Dimensions of Sexual Orientation and the Prevalence of Mood and Anxiety Disorders in the United States". American Journal of Public Health 100 (3): 468–475. doi:10.2105/AJPH.2008.152942. ISSN 0090-0036. PMID 19696380. PMC PMC2820045. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820045/. 
  14. Asnaani, Anu; Richey, J. Anthony; Dimaite, Ruta; Hinton, Devon E.; Hofmann, Stefan G. (2010-8). "A Cross-Ethnic Comparison of Lifetime Prevalence Rates of Anxiety Disorders". The Journal of nervous and mental disease 198 (8): 551–555. doi:10.1097/NMD.0b013e3181ea169f. ISSN 0022-3018. PMID 20699719. PMC PMC2931265. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931265/. 
  15. 15.0 15.1 Rettew, David C.; Lynch, Alicia Doyle; Achenbach, Thomas M.; Dumenci, Levent; Ivanova, Masha Y. (2009-09). "Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews" (in en). International Journal of Methods in Psychiatric Research 18 (3): 169–184. doi:10.1002/mpr.289. ISSN 1049-8931. http://dx.doi.org/10.1002/mpr.289. 
  16. Kessler, R. C., Avenevoli, S., Costello, E. J., Georgiades, K., Green, J. G., Gruber, M. J., . . . Merikangas, K. R. (2012). Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry, 69(4), 372-380. doi:10.1001/archgenpsychiatry.2011.160
  17. 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 17.33 17.34 17.35 17.36 17.37 17.38 17.39 17.40 17.41 17.42 17.43 17.44 A guide to assessments that work. Hunsley, John, 1959-, Mash, Eric J. New York: Oxford University Press. 2008. ISBN 9780195310641. OCLC 314222270.CS1 maint: others (link)
  18. 18.0 18.1 Chorpita, Bruce F.; Moffitt, Catherine E.; Gray, Jennifer (2005-03). "Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample". Behaviour Research and Therapy 43 (3): 309–322. doi:10.1016/j.brat.2004.02.004. ISSN 0005-7967. http://dx.doi.org/10.1016/j.brat.2004.02.004. 
  19. Chorpita, Bruce F; Yim, Letitia; Moffitt, Catherine; Umemoto, Lori A; Francis, Sarah E (2000-08). "Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale". Behaviour Research and Therapy 38 (8): 835–855. doi:10.1016/s0005-7967(99)00130-8. ISSN 0005-7967. http://dx.doi.org/10.1016/s0005-7967(99)00130-8. 
  20. Spitzer, Robert L.; Kroenke, Kurt; Williams, Janet B. W.; Löwe, Bernd (2006-05-22). "A Brief Measure for Assessing Generalized Anxiety Disorder" (in en). Archives of Internal Medicine 166 (10). doi:10.1001/archinte.166.10.1092. ISSN 0003-9926. http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.166.10.1092. 
  21. Meyer, T.J.; Miller, M.L.; Metzger, R.L.; Borkovec, Thomas D.. "Development and validation of the penn state worry questionnaire". Behaviour Research and Therapy 28 (6): 487–495. doi:10.1016/0005-7967(90)90135-6. https://doi.org/10.1016/0005-7967(90)90135-6. 
  22. Fresco, David M.; Mennin, Douglas S.; Heimberg, Richard G.; Turk, Cynthia L.. "Using the Penn State Worry Questionnaire to identify individuals with generalized anxiety disorder: a receiver operating characteristic analysis". Journal of Behavior Therapy and Experimental Psychiatry 34 (3-4): 283–291. doi:10.1016/j.jbtep.2003.09.001. http://linkinghub.elsevier.com/retrieve/pii/S0005791603000569. 
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  24. Hale III, WW; Raaijmakers, QA; van Hoof, A; Meeus, WH (2014). "Improving Screening Cut-Off Scores for DSM-5 Adolescent Anxiety Disorder Symptom Dimensions with the Screen for Child Anxiety Related Emotional Disorders.". Psychiatry journal 2014: 517527. PMID 24829901. 
  25. Hodges, Kay. "Depression and anxiety in children: A comparison of self-report questionnaires to clinical interview." (in en). Psychological Assessment 2 (4): 376–381. doi:10.1037/1040-3590.2.4.376. http://dx.doi.org/10.1037/1040-3590.2.4.376. 
  26. Seligman, LD; Ollendick, TH; Langley, AK; Baldacci, HB (September 2004). "The utility of measures of child and adolescent anxiety: a meta-analytic review of the Revised Children's Manifest Anxiety Scale, the State-Trait Anxiety Inventory for Children, and the Child Behavior Checklist.". Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 33 (3): 557-65. PMID 15271613. 
  27. Chorpita, BF; Yim, L; Moffitt, C; Umemoto, LA; Francis, SE (August 2000). "Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale.". Behaviour research and therapy 38 (8): 835-55. PMID 10937431. 
  28. Chorpita, BF; Moffitt, CE; Gray, J (March 2005). "Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample.". Behaviour research and therapy 43 (3): 309-22. PMID 15680928. 
  29. Spence, Susan H.. "A measure of anxiety symptoms among children". Behaviour Research and Therapy 36 (5): 545–566. doi:10.1016/s0005-7967(98)00034-5. https://doi.org/10.1016/S0005-7967(98)00034-5. 
  30. Spitzer, RL; Kroenke, K; Williams, JB; Löwe, B (22 May 2006). "A brief measure for assessing generalized anxiety disorder: the GAD-7.". Archives of internal medicine 166 (10): 1092-7. PMID 16717171. 
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