Pergamon Journal of Anxiety Diwrd crs, Vol. 10 , No. 2, pp. 97-114. 1996 Copyright &, 1996 Elsevier Science Ltd Printed in the USA. All rights mse twd 0887- 618396 $15.00 + .Ml SSDI 0887-61%5(95)00039-9 Anxiety Rating for ChiMr en - Revised: Reliab ility and Validity GAIL A. BERNSTEIN, M.D. Division of Child and Adolescent Psychiatry. Univer sity of Minnesota Medical School Ross D. CROSBY. PH.D. Department of Psychiatry, University of Minnesota Medical Scho ol A M Y R. Pt%RWIFN, .A. Division of Child and Adolescent Psychiatry. Univer sity of Minnesota Medical School CARRIE M . BORCHARDT, M.D. Division of Ch ild Md Ado lescen t Psychiatry, University of Minnesota Medical Scho ol Abstract - Th e purpo se of this investigation was to define the psychometric prop er- ties of the Anxie ty Rating for Child ren - Revise d (ARC-R), a clinician rating scale for the assessmen t of anxie ty sym ptom s i n chiidr en and adolescents. Th e A RC-R is comprised o f an Anxiety subscale and a Physiological subscale. In a clinical sample (N = 22). the test-retes t reliability and interrater reliability we re investiga ted. In a nonoverl apping clinic sample of school refusers (N = 199). the i nternal reliability and convergent, divergent, and discriminant val idi ty wer e evahtated. Test-retest (r = . 93) and interrater reliab ility (r = .95) were exce llent. There was good internal relia bility of items ( Cronbach’s alpha = .80). Th e Anxie ty subscale of the ARC-R correla ted Dr. Bernstein’s ef fo rt o n this manuscript was support ed i n part by Grant R29 MH4 653 4 from the National Institute o f Ment al Health. Th e authors thank John Hopwood, M.A. and Suzy Peterson, B.A. for their assistance n admin- istering the rating scales and Lois Laitinen, M.B.A., M.M. for manuscript prepar ation. Dr. Crosby is currently at NCS Assessments, Minnetonka, MN. Amy Perwi en is currently a gradua te student in the Department of Clinical and Health Psychology at the University of Flor ida. Requests for reprints should be sent to Gail A. Bernstein, M.D., Director, Divisio n of Child and Adolescent ps yc hia try , Box 95 UMHC, 420 Delawar e St SE, Minneapolis, MN 55455. 97
19
Embed
Anxiety Rating for Children - Revised Reliability and Validity
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
Journal of Anxiety Diwrd crs, Vol. 10 , No. 2, pp. 97-114.1996
Copyright &, 1996 Elsevier Science Ltd
Printed in the USA. All rights mse twd
0887-618396 $15.00 + .Ml
SSDI 0887-61%5(95)00039-9
Anxiety Rating for ChiMren - Revised:
Reliability and Validity
GAIL A. BERNSTEIN,M.D.
Division of Child and Adolescent Psychiatry. University of Minnesota Medical School
RossD. CROSBY. PH.D.
Department of Psychiatry, University of Minnesota Medical Scho ol
AMY R. Pt%RWIFN,.A.
Division of Child and Adolescent Psychiatry. University of Minnesota Medical School
CARRIE M. BORCHARDT, M.D.
Division of Ch ild Md Ado lescen t Psychiatry, University of Minnesota Medical Scho ol
Abstract - The purpose of this investigation was to define the psychometric proper-
ties of the Anxiety Rating for Children - Revised (ARC-R), a clinician rating scale
for the assessment of anxiety symptoms in chiidren and adolescents. The ARC-R is
comprised o f an Anxiety subscale and a Physiological subscale. In a clinical sample(N = 22). the test-retest reliability and interrater reliability were investigated. In a
nonoverlapping clinic sample of school refusers (N = 199). the internal reliability and
convergent, divergent, and discriminant val idity were evahtated. Test-retest (r = .93)
and interrater reliability (r = .95) were excellent. There was good internal reliability
of items (Cronbach’s alpha = .80). The Anxiety subscale of the ARC-R correlated
Dr. Bernstein’s effort on this manuscript was supported in part by Grant R29 MH46534 from the
National Institute of Mental Health.
The authors thank John Hopwood, M.A. and Suzy Peterson, B.A. for their assistance n admin-
istering the rating scales and Lois Laitinen, M.B.A., M.M. for manuscript preparation.
Dr. Crosby is currently at NCS Assessments,Minnetonka, MN.Amy Perwien is currently a graduate student in the Department of Clinical and Health
Psychology at the University of Florida.
Requests for reprints should be sent to Gail A. Bernstein, M.D., Director, Division of Child
and Adolescent psychiatry, Box 95 UMHC, 420 Delaware St SE, Minneapolis, MN 55455.
97
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
Seat, 1977). The Anxiety Rating for Children - Revised (ARC-R) is the only
clinician rating scale, to our knowledge, which was specifically developed to
assessanxiety symptoms in children and adolescents.
The ARC-R uses symptom clusters similar to those in the Hamilton
Anxiety Rating Scale (Hamilton, 1959) which was designed for use in adults.
The Hamilton Anxiety Rating Scale is used as an outcome measure in many
treatment studies of anxiolytic medications (Maier, Buller, Philipp, & Heuser,
1988). It has recently been demonstrated to be reliable and valid in an adoles-
cent sample (Clark & Donovan, 1994).
It has been noted that interview measures are often advantageous becausethey minimize differences in subjects’ interpretations of questions (Clark &Donovan, 1994). These scales are important assessment tools because they inte-
grate. both the clinician’s experience and expertise and the child’s report of anx-
iety symptoms. In addition, the ARC-R provides the clinician with a measure
of the severity of cognitive and somatic aspects of anxiety rather than being
based solely on DSM-N (American Psychiatric Association, 1994) criteria.
While parents can serve as a valuable source of information, the symptoms
experienced by children and adolescents with anxiety disorders are often inter-
nally or subjectively felt. Therefore, it is imperative that the children be inter-viewed about their anxiety symptoms. In a review of parent-child agreement in
clinical assessment, Klein (1991) concluded that the concordance between
children’s and parents’ reports of anxiety disorders is generally poor. In a study
by Herjanic and Reich (1982), children reported significantly more subjective
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
trointestinal, genitourinary, and autonomic. A behavioral observation item wasalso included in the original ARC. The items included in each subscale were
consistent with the concept of measuring anxiety that is used in the Hamilton
Anxiety Rating Scale (Hamilton, 1959). The ARC grouped symptoms together
by category.
The depressed mood item of the original ARC was deleted in the ARC-R
because the content overlapped with the content of the Children’s Depression
was felt that the revised version of the ARC would be a purer measure of anxi-
ety without the depression item. In addition, the sleep disturbance item wasdeleted due to poor psychometric properties (e.g., corrected item-to-total cor-
relation of .32 for sleep disturbance; .44-.68 for other items). Due to interest in
the investigation of somatic complaints, six physiological anxiety items were
revised in 1992. The genitourinary item was excluded because the content did
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
Children’s Depression Scale (CDS; Lang & Tisher, 1978). This self-report
depression scale includes 66 statements which are written on individual cards.Each card is sorted into one of five boxes (labeled from “very right” to “very
wrong”). The test-retest reliability at 7-10 days was good in a nonclinical sam-
ple (Tisher & Lang, 1983). Adequate internal consistency and concurrent
validity have been demonstrated (Knight, Hensley, & Waters, 1988; Rotundo
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
& Hensley, 1985). The CDS differentiates between children with and without a
diagnosis of depression (Knight et al., 1988).
Children’s Depression Rating Scale - Revised (CDRS-R; Poxnanski et al.,1985): This is an l&item clinician-rated scale for depression. High test-retest
reliability has been demonstrated (Poznanski et al., 1984). The instrument cor-
relates highly with other measures of depression supporting the convergent
validity of the scale. The CDRS-R discriminates depressed versus nonde-
pressed children (Poxnanski et al., 1984).
Statistical Analysis
Test-retest reliability was determined by Pearson correlation coefficients
between scores obtained at the two test administrations. Interrater reliability forsubscale and total scores was assessed using intraclass correlation coefficients
(Bartko & Carpenter, 1976). The internal reliability of the instrument was
assessedusing Cronbachs alpha. The association between measures was assessed
using Pearson correlations. Differences in ARC-R Anxiety subscale scores
between diagnostic groups were determined using one-way analysis of variance.
was performed to examine the diagnostic utility of the ARC-R Anxiety sub-
scale. This analysis is useful in characterizing the ability of a diagnostic instru-
ment to distinguish patients with a psychiatric disorder (“true positives”) fromthose without the disorder (“true negatives”) (Hsiao, Bartko, & Potter, 1989;
Murphy et al., 1987).ROC analysis evaluates the test performance of a diagnostic instrument
across the full range of test scores. For any given cutoff score on a diagnostic
instrument, the following values can be calculated: (a) the sensitivity, or “true
positive rate,” is the proportion of subjects with the disorder scoring at or
above that cutoff, (b) the specificity, or ‘true negative rate,” is the proportion of
subjects without the disorder scoring below that cutoff, and (c) the cumphnent
of sensitivity (i.e., one minus sensitivity), or the ‘false negative rate,” is the
proportion of subjects with the disorder scoring below that cutoff, and (d) the
complement of specificity, or “false positive rate,” is the proportion of subjectswithout the disorder scoring at or above that cutoff.
The ability of a diagnostic instrument to distinguish patients with a disorder
from those without the disorder can be graphically displayed using an ROC
curve. An ROC curve plots sensitivity (true positive rates) on the vertical axis
and one minus specificity (false positive rates) on the horizontal axis across all
possible cutoff scores. The diagonal line on the ROC curve, where true positive
rates are equal to false positive rates, represents the line of no information. The
greater the distance between the diagnostic test’s ROC curve and the line of noinformation, the better the diagnostic performance of the instrument. Statistical
methods are available for estimating the area under the ROC curve (AUC) and
its standard error (Hanley & McNeil, 1982). The AUC provides an estimate of
the probability that a randomly chosen subject with an anxiety diagnosis will
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
Average interitem correlation for the Physiological subscale was .28 (range
= .08 to SO); corrected item-to-total correlations ranged from .34 (gastroin-
testinal) to -57 (muscular). Cronbach’s alpha was .69 for the six Physiologicalitems (N = 26). Cronbach’s alpha was .80 when the two subscales were com-
bined (N = 26).
All analyses of the validity of the measure used the subscales included in
the ARC-R. The ARC-R is basically a subset of items from the ARC. The
ARC was revised to form the ARC-R by deleting the depression, sleep distur-
bance, genitourinary, and behavioral observation items.
The validity results are based on the ARC-R Anxiety subscale, not the total
ARC-R scale. Pearson correlation coeffkients between the ARC-R Anxiety
subscale (sum of the five anxiety items) and subjects’ scores on Anxiety andDepression rating scales scores are summarr ‘zed in Table 3. The correlations
between the ARC-R Anxiety subscale and scores on the self-report anxiety
instruments were higher (r = .62) than the correlations between the ARC-R
Anxiety subscale and scores on the self-report depression instruments
(r = 54-56). However, the difference between these correlations is not signif-
icant based on the z statistic. All correlations in Table 3 are at p < .OOl level.
To explain the .67 correlation between the Anxiety subscale of the ARC-R and
CDRS-R, the analysis was repeated with anxiety disorder only patients and
resulted in a correlation of r = .58. For depression only patients the correlation
was r = .66.Pearson correlation coefficients between the ARC-R Physiological subscale
(includes six items) and anxiety measures were not significant, although the
correlation between the RCMAS Physiological subscale and the ARC-R
The mean score for the entire sample (N = 199) on the Anxiety subscale
was 5.9 f 3.7, with a range from 0 to 18. The mean score on the Physiological
subscale (N = 26) was 4.6 f 2.9, with a range from 0 to 9.
Analysis of variance (ANOVA) showed a significant difference in anxiety
subscale score among the three diagnostic groups (F = 9.96, df = 2, 124,
p = .OOOl). The mean score for the anxiety disorder group was highest at 6.2 it
3.6. The mean score for the depression group was 4.5 f 2.8 and the mean score
for the no anxiety or depressive disorder group was 3.0 f 2.0.
Following ANOVA, the Tukey-HSD Multiple Range Test was completed to
evaluate pairwise comparisons between groups. The anxiety disorder group
scored significantly higher than each of the other two diagnostic groups on the
anxiety subscale. There was no significant difference on Anxiety subscale scorebetween the depressive disorder and no anxiety or depressive disorder groups.
TABLE 4
COMPARISON OF FEMALES AND hhLE.S ON RATIN G SCALES
The ROC analysis evaluating the ability of the ARC-R Anxiety subscale to
distinguish subjects with an anxiety diagnosis from those without an anxiety
diagnosis is presented in Figure 1. The figure presents sensitivity (true positiverate) and one minus specificity (false positive rate) values for cutoffs between
1 and 12. The AUC is .70 (SD = .05), which is significantly higher than the
line of no information (p < .oOl).
The ROC curve can be used to determine, for a given cutoff score, what
percentage of subjects with and without an anxiety disorder scored at or above
(or conversely, below) that point. For example, the values corresponding to a
cutoff score of 4 are: sensitivity = .75; one minus specificity = .42. This would
indicate that 75% of subjects with an anxiety disorder scored 4 or higher (i.e.,
sensitivity = .75) while only 25% scored below 4. Similarly, 58% of all sub-jects without an anxiety disorder scored below 4 (i.e., specificity = .58), while42% scored 4 or above. A cutoff value of 3 would result in a sensitivity of .82
and a specificity of .31; a cutoff value of 5 would result in a sensitivity of .67
and a specificity of .6 1.
DISCUSSION
The ARC-R, to the best of our knowledge, is the only clinician rating scale
for anxiety that is specifically designed for use in children and adolescents.
0.4 WC = .70
SD=.06
0.0 0.2 0.4 0.6 0.8 1.0
(7 - Specificity)
FIG. 1. ARC-R AMuen Smsax.e ROC CURVE.
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
The test-retest reliability of r = .93 for the total Anxiety score indicates stabili-
ty of the measure over a short period of time for which the instrument assesses.
Test-retest reliability was evaluated by using older children and adolescents(11-18 years old). Reliability of the ARC-R may have been influenced by the
subjects’ ages because reliability has been shown to increase with age
Briggs, & Crowther, 1994). Interrater reliability of .95 indicates agreement of
raters when using the instrument, The instrument also has good internal relia-
bility (Cronbach’s alpha of .80). These properties indicate that the ARC-R is a
reliable measure of clinician rated anxiety.
Correlations between the Anxiety subscale of the ARC-R and RCMAS
(r = .62) (Table 3) and between the anxiety subscale of the ARC-R and the
VAA-R (r = .62) suggest all three anxiety scales are measuring similar con-
structs and support the convergent validity of the instrument. Gf the three sub-
scales on the RCMAS, the ARC-R Anxiety subscale correlates best with the
Worry/Oversensitivity subscale (r = .61), which has been identified as the sub-
scale on the RCMAS that best identifies children with anxiety disorders
(Mat&on, Bagnato, & Brubaker, 1988). In a study of referred children, only
the wonyloversensitivity factor of the RCMAS significantly distinguished the
anxiety group from the psychiatric control group (Mattison et al., 1988).
The correlations between the Anxiety subscale of the ARC-R and self-
report anxiety instruments (r = .62) were higher than the correlations betweenthe Anxiety subscale of the ARC-R and self-report depression instruments
(r = .54-.56) (Table 3), providing some support for the divergent validity of
the instrument. Although the correlation between the ARC-R Anxiety sub-
scale and CDRS-R was r = .67, this may be explained by the observations that
both are clinician ratings and that there is a substantial rate of comorbidity of
anxiety and depression in this sample. Scoring high on both anxiety and
depression instruments may reflect the child or adolescent experiencing both
anxiety and depressive symptoms (Bernstein & Garfinkel, 1992). More symp-
tomatic children and adolescents often have high scores on multiple measuresas a function of their severity (Bernstein, 1991). If only subjects with pure
anxiety disorders were included, the correlation between the ARC-R Anxiety
subscale and CDRS-R was lower (r = S8).
Furthermore, anxiety instruments do not always measure pure anxiety symp-
tomatology, nor do depression instruments measure pure depressive symptoms
(Bernstein & Garfinkel, 1992). Moderate correlations between anxiety and
depression instruments are consistently reported in assessment of children and
adolescents (Strauss, Lease, Last, & Francis, 1988). Nevertheless, the finding
that there are moderate correlations between the ARC-R Anxiety subscale and
the depression scales suggest a potential shortcoming of this instrument.
Further investigation of the relationship between the ARC-R and measures of
depression in a larger, pure anxious sample is needed to evaluate the divergent
validity of the ARC-R.
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
The Physiological subscale of the ARC-R only correlated significantly with
the CD1 (r = .41) and the CDRS-R (r = .52). Due to the small sample size used
to evaluate the Physiological subscale (N = 26), these correlations and othercorrelations between the Physiological subscale and measures of anxiety and
depression should be viewed as preliminary. However, it appears that somatic
complaints may be symptoms of depression as well as symptoms of anxiety. In
a study by McCauley, Carlson, and Calderon (1991) exploring the relationship
between anxiety, depression, and somatic complaints, the presence and severi-
ty of depression predicted somatic complaints, even when anxiety was con-
trolled. Furthermore, a substantial number of the subjects who met criteria for
depression had moderate to severe somatic complaints. The authors concluded
that the association between depression and somatic complaints could not beaccounted for by anxiety.
Females scored significantly higher than males on the Anxiety subscale.
Females also were higher than males on the Physiological subscale, although
this finding was not statistically significant. The gender differences on the ARC-
R are consistent with gender findings on other anxiety measures (Bernstein &
Garilnkel, 1992; Ollendick et al., 1989; Reynolds & Richmond, 1985).
Children and adolescents with a DSM-III-R anxiety disorder had signifi-
cantly higher scores on the Anxiety subscale than those without an anxiety
disorder. This finding provides data for the discriminant validity of the
Anxiety subscale of the ARC-R. However, a limitation of this study is the useof retrospective chart reviews for establishing the diagnoses of the subjects.
The methodology would have been stronger if structured psychiatric inter-
views had been used for diagnoses. Therefore, the conclusions about discrim-
inant validity need to be viewed tentatively.
The diagnostic utility of the ARC-R Anxiety subscale in screening for anxi-
ety disorder in psychiatric patients is suggested by the ROC analysis. The
Anxiety subscale was shown to significantly differentiate between psychiatricpatients with and without anxiety disorders. Cutoff points of 4 or 5 appear
most appropriate in providing an optimal balance between sensitivity andspecificity. Further study is needed to determine the diagnostic utility of the
ARC-R in a nonpsychiatric setting.Somatic complaints are often a manifestation of anxiety. Because it mea-
sures somatic symptoms, the ARC-R may prove to be particularly useful withthe changes made from DSM-III-R (American Psychiatric Association, 1987)
to DSM-ZV (American Psychiatric Association, 1994). Criteria for separation
anxiety disorder, generalized anxiety disorder, and panic disorder emphasize
physical symptoms associated with anxiety. Therefore, with DSM-ZV, more
attention will be focused on somatic symptoms as we diagnose children and
adolescents with anxiety symptoms.
Studies evaluating somatic symptoms in anxious children suggest that fur-
ther investigation, with an instrument such as the ARC-R, will be fruitful.
Several studies have noted that somatic complaints are common in children
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
In our experience with the ARC-R, some youth appear to minimize their
anxiety symptoms on the five psychological anxiety items, but readily endorse
multiple symptoms on the six physiological items. Perhaps they find it more
acceptable to report physical symptoms than emotional symptoms. The use of
only 26 outpatients in the evaluation of the Physiological subscale is a short-
coming of the validation study. However, data on the psychometric properties
of this subscale are currently being collected. The entire ARC-R instrument is
currently being used as an outcome measure in a treatment study of school-
refusing adolescents with comorbid anxiety disorder and major depression. It
will be of interest in the study to examine the relationship between change on
the Anxiety subscale and change on the Physiological subscale.
The ARC-R is a reliable instrument for clinician-rated anxiety in children
and adolescents. The validity of the Anxiety subscale has been established.
This instrument fills the void of a much needed clinician rating scale for anxi-ety. It provides the advantage of assessing both psychological and physiologi-
cal symptoms of anxiety. Its psychometric properties justify the use of this
rating scale as a clinical instrument for assessing anxiety and demonstrate its
usefulness as a screening instrument. As a research instrument, the ARC-R
may also prove to be an effective tool in evaluating the efficacy of treatments
for anxiety in children and adolescents.
The ARC-R complements the other anxiety instruments currently available by
providing a perspective that is not bound by DW-ZV criteria, as in sbrucRued and
semistru~ interviews. It also overcomes some of the potential weaknesses ofself-report and parental report measures because it integrates the clinician’s exper-
tise with the child or adolescent’s report of symptoms. The ARC-R would be most
useful as part of a comprehensive assessment which includes a diagnostic inter-
view, self-report measures of anxiety and depression, and parental report measures.
REFERENCES
Achenbach, T. M. (1991). M anual for the chil d behavior checklist/4-(18) and 1991 profile.
Burlington, VT: Universi ty of Vermont Department of Psychiatry.
American Psychiatric Association (1987). Diagno stic and statistical manual of mental disorders
(3rd ed.. rev.). Washington, DC: Author.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington. DC: Author.
Bartko, J. J.. & Carpenter. W. T. (1976). On the methods and theory of reliability. Journal of
NervousandMentalDiseose, 163.307-317.
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity
Livingston, R. Taylor, J. L., & Crawford, S. L. (1988). A study of somatic complaints and psychiatric
diagnosis in childten. Journal of the American Academy of Child ad Aabkmwt Psych&y, 2’7,
185-187.
McCauley, E., Carbon. G. A., & Calderon, R. (1991). The role of somatic complaints in the diag-
nosis of depression in children and adolescents. Journul of the American Academy of Child
and Adolescent Psych&y, 38.631-635.
Maier, W., Buller, R., Philipp, M., % Heuser, I. (1988). The Hamilton Anxiety Scale: Reliability,
val idity and sensitivity to change in anxiety and depressive disorders. Joum~l ofA$xtive
Disorders, 14,61.
Mattison, R. E., Bagnato, S. J., & Brubaker, B. H. (1988). Diagnostic util ity of the Revised
Children’s Manifest Anxiety Scale in children with DSM-III anxiety disorders. Jourrud of
Anriefy Disonlers, 2.147-155.
Mote& M. M., Fine, S., Haley, G., Bi Marriage, K. (1985). Childhood and adolescent depression:
Child-report versus parent-report information. Journal of the American Academy of Child
Psychiatry, 24,298-302.
Murphy, J., Berwick, D., Weinstein, M., Borus. J., Budman. S., 8i Klerman, G. (1987).
Performance of screening and diagnostic tests. Archives of General Psych&y, 44.550-555.
Ollendick, T. H. (1983). Reliability and val idity of the Revised Fear Survey Schedule for Children
(FSSC-R). Behuviour Resea rch and Therapy, 21,685-692.
Ollendick. T. H., King, N. J., & Frary, R. B. (1989). Feats in children and adolescents: Reliability
and generalizability across gender, age and nationality. Behnviour end Resea rch The rapy, 27,
19-26.
Poznanski, E. 0, Freeman, L. N., & Moktos, H. B. (1985). Children’s Depression Rating Scale -
Revised. Psychopharmacology Bulletin, 4.979-989.
Poznanski, E. 0.. Grossman, J. A., Buchsbaum, Y., Banegas, M., Freeman, L., & Gibbons, R.
(1984). Preliminary studies of the reliability and val idity o f the Children’s Depression RatingScale. Joumol of the American Academy of Child Psychiatry. 23,191-197.
Reynolds, C. R. (1980). Brief reports: Concurrent val idity of What I Think and Feel: The Revised
Children’s Manifest Anxiety Scale. Joumnt of Consulting and Clinical Psychology, 48,
774-775,
Reynolds, C. R., & Richmond, B. 0. (1978). What I think and feel: A revised measure of chil-
dren’s manifest anxiety. Journal of Abnormal Child Psychology, 6.271-280.
Reynolds, C. R., & Richmond, B. 0. (1985). Revised Childre n’s Manifest Anxiety Sca le (RCMAS)
menuul. Los Angeles, CA: Western Psychological Services.
Rotundo, N., & Hensley, V. R. (1985). The Children’s Depression Scale. A study of its volidiry.
Joum ~l of Child Psychology and Psychiatry, 26.917-927.
Saylor, C. F., Finch, A. J., Spirito, A., & Bennett, B. (1984). The Children’s Depression Inventory:A systematic evaluation of psychometric properties. Journal of Consulting and Cfinical
Psychology, 52,955-967.
Schwab-Stone, M., Fallon, T.. Briggs, M., Crowther, B. (1994). Reliability of diagnostic reporting
for children aged 6-1 I years: A test-retest study of the Diagnostic Interview Schedule For chil-
dren -Revised. Ame rican Journa l of Psychiatry, 151.1048-1054 .
Shain, B. N., Naylor, M. & Alessi. N. (1990). Comparison of self-rated and clinician-rated mea-
sures of depression in adolescents.Ame rican Jourm al of Psychinrry, 147.793-795.
Silverman, W. K., & Nelles, W. B. (1988). The Anxiety Disorders Interview Schedule for
Children. Journal of the American Academy of Child and Adolescenr Psychintry. 27,772-778.
Spielberger, C. (1973). Manual for the State-Tra it Anxiety Inventory for Children. Palo Alto:
Consulting Psychologists Press.
Strauss, C. C., Lease, C. A., Last, C. G., & Francis, G. (1988). Overanxious disorder: An examina-
tion of developmental differences. Journal ofAbnomw[ Child Psychology, 16,433-443.
Tisher, M., & Lang, M. (1983). The Children’s Depression Scale: Review and further develop-
ments. In D. P Cantwell & G. A. Carlson (Eds.), Affective disorders in childhood and ndofes-
cence: An update (pp. 181-203). New York: Spectrum Publications.
7/30/2019 Anxiety Rating for Children - Revised Reliability and Validity