When screening for anxiety disorders, a score of 8 or greater represents a reasonable cut-point for identifying probable cases of generalized anxiety disorder ; further diagnostic assessment is warranted to determine the presence and type of anxiety disorder. Based on a recent meta-analysis, some experts have recommended considering using a cut-off of 8 in order to optimize sensitivity without compromising specificity 2.
Although designed as a screening tool for generalized anxiety, the GAD-7 is also performs reasonably well as a screening tool for three other common anxiety disorders—Panic Disorder, Social Anxiety Disorder, and Posttraumatic Stress Disorder.
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Sign In or Register. Over the last 2 weeks , how often have you been bothered by the following problems? Social-Emotional-2nd edition ASQ:SE-2 — P arents complete the short, simple questionnaires at eight designated age intervals: 6, 12, 18, 24, 30, 36, 48, and 60 months. A 35 item questionnaire to screen for cognitive, emotional and behavioral problems. A 25 item questionnaire to identify and assess changes in emotional and behavioral problems in children.
The SDQ covers a broad range of emotional and behavioral issues and is designed to provide assessment of psychosocial functioning. Hand scoring information is available, however, the developers recommend using the online scoring system available through their website.
The tool does not identify OCD or trauma related anxiety. The scale does not identify trauma related anxiety. Therefore, not all children who score at risk will be diagnosed with ASD. The CARS2 has three forms. Prevalence rates on child-report, parent-report and combined report of anxiety disorders , dysthymia, depression and attention deficit hyperactivity disorder in high-anxious and median-anxious children, and statistical comparison Chi-square of groups on prevalence rates of combined reports.
Additionally, in diagnosed high-anxious children, the average number of anxiety diagnoses was 2. In order to measure whether the anxiety disorders were predicted by their corresponding subscale of the SCARED, hierarchic logistic regression analyses were performed. The results of these analyses are depicted in Table 4.
Logistic regression analyses with the SCARED subscales as independent variables and the combined child—parent anxiety diagnosis as the dependent variable.
It appeared that the disorders separation anxiety disorder, social phobia, and specific phobia were predicted by their corresponding subscale on the SCARED That is, other subscales did not contribute significantly to the prediction of separation anxiety disorder, social phobia and specific phobia than their matching SCARED subscales.
The diagnosis generalised anxiety disorder was not predicted significantly by any of the included subscales of the SCARED Both groups received a diagnostic interview separate child and parent interviews to check for the presence of anxiety disorders.
With respect to the tested hypotheses, it was found that: 1 high-anxious children had more often, and more severe anxiety diagnoses compared to median-anxious children; 2 high-anxious children and median-anxious children did not differ with respect to dysthymia, depression, and attention deficit hyperactivity disorder; 3 the diagnoses separation anxiety disorder, social phobia, and specific phobia were specifically predicted by their matching subscales on the screening questionnaire; 4 the diagnosis generalized anxiety disorder was not predicted by any of the included subscales the SCARED However, the prevalence numbers of anxiety disorders in both groups are fairly high.
They exceed the general lifetime prevalence estimation of 9. Two methodological explanations can be offered for the high prevalence rates of anxiety disorders in both groups. First, we used a combined parent-child diagnosis, whereas most studies [e. Because of the low correspondence between the children and their parents with regard to the type of anxiety disorder, the combination of the parent and child scores is likely to yield higher prevalences of anxiety diagnoses.
Second, we compared high-anxious children to median-anxious children, whereas low-anxious children were excluded from participation. Despite these methodological explanations, prevalence rates remain high in both groups, especially in the median-anxious group.
In fact, children considered as normal anxious in the s, scored higher on self-reported anxiety compared to child psychiatric patients in the s [ 54 ]. Anxiety has thus been found to increase over time. However, it would be too premature to draw conclusions on whether the methodological or time-related aspects caused the fairly high prevalence rates of anxiety disorders in the current study.
Even though studies that selected children via clinical settings showed high comorbidity between anxiety and other mental health problems [ 51 ], in this study high-anxious and median-anxious children did not differ with respect to the number of the disorders dysthymia, depression, and attention deficit hyperactivity disorder. The low comorbidity of anxiety disorders with dysthymia, depression, and attention deficit hyperactivity disorder is likely to result from two characteristics of our sample, being a community sample and a young sample, aged 8— As mentioned before, anxiety disorders are chronic if untreated and, as a consequence, can lead to other mental health disorders [ 3 , 9 , 31 , 43 , 51 , 56 ].
Children are thought to have better perceptions of their anxiety than parents. Horowitz, for example, noted that parents are less likely to be aware of internalising problems compared to externalising problems [ 27 ].
This is supported by the low referral in the high-anxious groups, which is, at this age, usually instigated by the parents or school. However, even though correspondence between the parent and the child on the interview was found to be low, parents did not report less anxiety disorders compared to the children.
We employed logistic regression analyses to test the expectation that the diagnoses specific phobia, social phobia, separation anxiety disorder, and generalised anxiety disorder were specifically predicted by their corresponding subscale of the screening instrument in the high-anxious group. The expectation was partly supported. It appeared that the three of the most prevalent disorders separation anxiety disorder, social phobia and specific phobia were only predicted by their corresponding subscales on the screening questionnaire.
The finding of the specific correspondence between the social phobia and separation anxiety disorder subscales of the screening questionnaire with their matching diagnoses is in accord with the study of Muris and colleagues using clinically anxious children [ 34 ].
However, an earlier study of Muris with elementary school children [ 36 ] found that the diagnosis social phobia was predicted by the subscale separation anxiety disorder. Possibly, the elaboration of the social phobia subscale with 5 items, lead to a better predictive value of that SCARED subscale.
Perhaps children of this age have difficulty understanding the concept of worrying e. Generalised anxiety disorder generally has higher comorbidity rates than other anxiety disorder and is highly comorbid with major depression [ 15 ].
More research is clearly necessary on how to detect generalised anxiety disorder in children aged 8— The pre-selection of groups in high- and median-anxious was based on child report on an anxiety symptoms questionnaire.
Although it is generally assumed that children are the most reliable reporters of internalising symptoms, children who underestimate their anxiety have not been selected in the high-risk group. Further studies are needed to investigate to what extent combining child report with that of knowledgeable others e. Approximately half of the children that were approached for the screening completed the screening questionnaire and approximately half of those identified as high- or median-anxious participated in the diagnostic interview.
Results of this study that are based on this sample should, therefore, be generalised to the entire population with care. The possibility that motivation or elevated anxiety levels are related to participation rate should be considered. However, comparable and even lower participation rates are found in other anxiety prevention studies. For example, in an indicated prevention trial of Rapee and colleagues, The low participation rates should, therefore, be considered as a reflection of difficulties of programs aimed at prevention rather than as a limitation of the current study.
The cross-sectional nature of the study concerns another limitation. Even though the main aim was to investigate the usefulness of screening methods in anxiety, longitudinal studies are preferred in order to properly examine time related developments of prevalence rates and the predictive value of the screening questionnaire for the development of anxiety disorders.
In case anxiety disorders are not managed in an early stage, the anxious individual is less likely to seek professional help, whereas he or she is more likely to develop more severe anxiety disorders, or other disorders. It is, therefore, of importance to stimulate the identification of dysfunctional anxiety in an early stage. Results from this study point to the usefulness of screening procedure, as children with high total scores high-anxious had more and more severe anxiety disorders than children with total scores from 2 points below to 2 points above the median median-anxious.
In addition, separation anxiety disorder, social phobia, and specific phobia, all diagnoses known to be prevalent and debilitating, were predicted by their corresponding subscales of the SCARED Future studies should investigate if high-anxious children are not only at risk for current anxiety disorders, but also for the development of future anxiety disorders and for a chronic course of anxiety disorders. In longitudinal studies, the effect of the employment of lower cut-off scores could be examined as well, in order to establish to what extend these children are at risk for developing anxiety disorders in the future.
The authors thank the participating children and their families. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author s and source are credited.
Ellin Simon, Email: ln.
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