A Parental Report of Children S Anxiety Symptoms
A parental report of children’s anxiety symptoms
A parental report of children’s anxiety symptoms in Japan: Psychometric properties of the Spence Children’s Anxiety Scale for Parents in a community sample
Shin-ichi Ishikawa1), Saki Shimotsu2), Tetsuya Ono3), Satoko Sasagawa4), Kiyomi Kondo-Ikemura3), Yuji Sakano3), & 5)
1 Faculty of Psychology, Doshisha University
2 Nozaki Hospital
3 School of Psychological Science, Health Sciences University of Hokkaido
4 Faculty of Human Sciences, Mejiro University
5
Correspondence should be directed to Shin-ichi Ishikawa, Faculty of Psychology, Doshisha University. 1-3 Tatara Miyakodani, Kyotanabe City, Japan. 610-0394. Tel & Fax: +81-774-65-7092. Email address:
Abstract
This study investigated anxiety symptoms in Japanese children from parent-report as part of the process of developing the Spence Children’s Anxiety Scale for Parents (SCAS-P). The participants were 677 parents and children aged 9 to 12 years. Confirmatory factor analysis revealed that the SCAS-P had a 6-factor structure. The scale showed satisfactory internal consistency and good convergent validity with a subscale of the Child Behavior Checklist. A MANOVA indicated no significant gender or age differences for the total scale score or any subscale scores. Among Japanese children, the most prevalent symptoms within the parental report were items related to fear of the dark and of insects/spiders. Finally, we observed very low correlations between parental and child reports of anxiety symptoms; the relationships between child and parental reports were rather poor in Japanese children. We briefly discuss the utility of the SCAS-P as a screening instrument for parental reports of anxiety symptoms.
Keywords: anxiety, children, parent, assessment, Spence Children’s Anxiety Scale
A parental report of children’s anxiety symptoms in Japan: Psychometric properties of the Spence Children's Anxiety Scale for Parents in a community sample
Over the past decade, the field of child psychology has made significant strides in developing evidence-based methods and instruments for assessing anxiety and its related disorders (Silverman & Ollendick, 2005). Following from the development of traditional measures, such as the Revised Children’s Manifest Anxiety Scale (Reynolds & Richmond, 1985), new multidimensional assessments have been established to measure the different types of childhood anxiety disorder symptoms within the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994). For this purpose, two standardized instruments have been developed: the Spence Children’s Anxiety Scale (SCAS; Spence, 1998) and the Screen for Child Anxiety Related Emotional Disorders (SCARED; Birmaher, Khetarpal, Brent, Cully, Balach, Kaufman, & Neer, 1997).
The SCAS is a 38-item self-report questionnaire that assesses multiple symptoms of childhood anxiety disorders based on current diagnostic criteria. The subscales of the SCAS correspond with the diagnostic classification system of the DSM-IV. Reliability and validity were confirmed in a survey involving 2,052 Australian children aged 8–12 years (Spence, 1998). Researchers and clinicians can use the SCAS to measure overall anxiety levels as well as anxiety symptoms related to obsessive-compulsive disorder, separation anxiety disorder, social phobia, panic/agoraphobia, generalized anxiety/overanxious disorder, and physical injury fears. The SCARED originally had been established as a 38-item scale for parental and child self-reports (Birmaher et al., 1997). After adding three items related to social phobia, the 41-item version of the SCARED was re-administered to outpatient children, adolescents, and parents (Birmaher, Chiappetta, Bridge, Monga, & Baugher, 1999). Factor analysis for the 41-item version supported a 5-factor structure: panic/somatic, generalized anxiety, separation anxiety, social phobia, and school phobia. In general, the total scale and subscales scores for the SCARED demonstrated good internal consistency and discriminant validity.
Although both scales have corresponded with current diagnostic criteria with satisfactory internal consistency, test-retest reliability, and sufficient validity, it has been argued that the SCAS and SCARED have some differences. For instance, despite fewer items, the SCAS shows a broader scope and a closer connection to the DSM-IV structure. Specifically, the social phobia subscale more closely corresponds to the DSM-IV. Furthermore, since the SCAS items are based on 4-point scales, the SCAS has a broader range of possible answers (Nauta, Scholing, Rapee, Abbott, Spence, & Waters, 2004; Whiteside & Brown, 2008). Finally, the SCAS has been translated into various languages and used in several countries, including the Netherlands (Muris, Schmidt, & Merckelbach, 2000), Belgium (Muris, Merckelbach, Ollendick, King, & Bogie, 2002), Germany (Essau, Muris, & Ederer, 2002), South Africa (Muris, Schmidt, Engelbrecht, & Perold, 2002), and Japan.
Ishikawa and colleagues investigated anxiety symptoms among Japanese children and adolescents using the SCAS Japanese version (Ishikawa, Sato, & Sasagawa, 2009). Factor analysis using a multi-group method based on data from 1,046 children and 1,182 adolescents supported a 6-factor model with a single higher-order factor reflecting the original factor structure (Spence, 1997; 1998). Scores for overall anxiety symptoms and each subscale were similar when comparing the Japanese sample with samples from other countries. For instance, girls reported more anxiety symptoms than boys, and adolescents presented with fewer anxiety symptoms than younger children. However, the items most frequently endorsed by Japanese students differed from those endorsed by Western students. Specifically, the most common item endorsed by Japanese children was related to obsessive-compulsive disorder (“I have to keep checking that I have done things right, like the light switch is off, or the door is locked”); this item was not common for German children (Essau, Sakano, Ishikawa, & Sasagawa, 2004), or Australian adolescents (Spence, Barrett, & Turner, 2003). Conversely, the lower frequency of anxiety symptoms was nearly the same between the Japanese and Western samples from previous studies.
One limitation of Ishikawa and colleagues’ (2009) study was that it only relied on youth self-reports. The SCAS also has a parent version: the Spence Children’s Anxiety Scale for Parents (SCAS-P; Nauta et al., 2004). The SCAS-P items correspond with the child version, and a confirmatory factor analysis supported the 6-factor structure that was consistent with the SCAS. While child self-reports provide useful information, parental reports are also important in the cross-cultural study of childhood anxiety disorders. For example, children with generalized anxiety disorders sometimes present with socially desirable behaviors (see Kendall, Krain, & Treadwell, 1999) and can be very socially gracious, eager to please, and charming (Olelndick & Ishikawa, in press). Within Asian countries, such behavior is likely to be viewed positively. For example, shy and sensitive children and adolescents are likely to be more accepted by their peers, parents, and teachers in China (see Chen, Chen, Li & Wang, 2009). Moreover, if not too excessive, socially anxious behaviors, such as being non-assertive, humble, and inhibited, are viewed as favorable in Japan (Ishikawa et al., 2008). In light of these indications, adults who are in contact with a child that has anxiety symptoms are likely to overlook the underlying problem, even if the child subjectively feels an impairment. Therefore, more information is necessary regarding parental reports of childhood anxiety symptoms among Asian countries.
The purpose of the current study was to examine the psychometric properties of the SCAS-P in a sample of parents who had a child in elementary school. This was part of the process of developing the Japanese version of the SCAS-P. Second, we examined the factor structure of the SCAS-P in an Asian sample. Third, internal consistency and concurrent validity of the SCAS-P were evaluated. Finally, the relationship between child self-reports and parental reports of anxiety symptoms were investigated.
Methods
Participants
Participants for this study were parents who had a child aged 9 to 12 years old. Parents were selected from six public elementary schools in the suburban area of Gunma and Miyazaki, Japan. In total, 714 parents consented to participate, and 677 parents and children completed the questionnaires (parents’ mean age = 40.44, SD = 5.50). Their children consisted of 341 boys and 336 girls (mean age = 10.70, SD = 0.95). Most respondents were mothers (n = 568, 83.90%) with 59 fathers, 7 grandmothers, and 1 uncle completing the questionnaires.
This study was approved by the IRB from the third and fifth author’s university. Based upon Japan’s IRB requirements, information about SES could not be collected; however, most respondents were middle-class, and there were very few families with a low SES. In addition, most participants were Japanese, and all participants could read/write Japanese. Since most of the children had resided exclusively in Japan, no significant differences in cultural background emerged.
Measures
Spence Children’s Anxiety Scale for Parents (SCAS-P). The Japanese version of the SCAS-P was developed to assess children’s anxiety symptoms on the basis of a parental report. The items from the original version of the SCAS-P were formulated, as closely as possible, to the corresponding items from the child version of the SCAS (Spence, 1997). There were 38 items in the SCAS-P scored on a scale from 0 (never) to 3 (always). The SCAS-P consisted of 6 subscales: separation anxiety disorder (SAD; 6 items), social phobia (SoPh; 6 items), generalized anxiety disorder (GAD; 6 items), panic attack and agoraphobia (Panic/Ag; 9 items), obsessive-compulsive disorder (OCD; 6 items), and physical injury fears (PhInj; 5 items). In the original study (Nauta et al., 2004), a confirmatory factor analysis supported the 6-factor structure that was consistent with the child version of the SCAS, and this factor structure reflected the specific anxiety disorder subtypes within the DSM-IV. Internal reliabilities of the subscales were satisfactory for the community and clinical samples (.61-.92). Convergent and divergent validity were also confirmed by correlations between other parental and child reports.
Child Behavior Checklist (CBCL).The CBCL (Achenbach, 1991) was designed to capture information across a broad range of children’s behavioral and emotional problems. This scale is a standardized measure where parents report on their children’s problems. The version used for children aged 4 to 18 years (CBCL/4 to 18) includes 118 items. In terms of children’s behavioral and emotional problems, parents were asked to evaluate each description on a scale from 0 (not true) to 2 (very true or often true). The CBCL has been used worldwide. The Japanese version of the CBCL has also been established, and its reliability and validity has been confirmed in several studies (Itani, Kanbayashi, Nakata, Kita, Fujii, Kuramoto, Negishi, Tezuka, Okada, & Natori, 2001; Nakata, Kanbayashi, Fukui, Fujii, Kita, Okada, & Morioka, 1999; Togasaki & Sakano, 1998). For the current study, 14 items dealing with anxiety/depression were used.
Spence Children’s Anxiety Scale (SCAS). The SCAS (Spence, 1998) is a 38-item self-reported measure of anxiety symptoms designed for children and adolescents. The SCAS has 6 factors that correspond with the SCAS-P: SAD, SoPh, GAD, Panic/Ag, OCD, and PhInj. The Japanese version of the SCAS (Ishikawa et al., 2009) has sufficient reliability coefficients: .94 and .92 for the full scale scores of children and adolescents, respectively. In addition, the scale has sufficient test–retest reliabilities: r = .76 for children and r = .86 for adolescents (ps < .001). Each item was rated on a 4-point scale in terms of its frequency ranging from 0 (never) to 3 (always).
Procedure
The main aims and methods of the present study were explained to the school principals and teachers. After the school gave their approval, the questionnaires were distributed to the children. Children completed the SCAS as a homeroom activity. The children then brought the questionnaires and a consent form home for their parents. Parents only completed the questionnaires when they consented to participate. Students handed in the completed questionnaires, which were sealed by their parents before submission.
The SCAS-P was translated according to widely accepted guidelines for the successful translation of instruments in cross-cultural research (Brislin, 1970). One bilingual translator, who was a native Japanese speaker or understood Japanese culture, blindly translated the questionnaire from the original English version into Japanese. Another bilingual translator back-translated the questionnaire into English. Differences in the original and the back-translated versions were discussed and resolved by joint agreement of both translators.
Results
Preliminary analysis
Since most of participants for the parental reports were mothers, we only used data from mothers for the following analyses1. There were no significant differences between fathers’ and mothers’ scores on the SCAS-P except for the social phobia subscale, t (625) = 4.812, p < .05. Mothers reported higher social anxiety symptoms than did fathers. Table 1 shows descriptive statistics of each item from mothers’ SCAS-P reports.
Confirmatory Factor analysis
According to previous studies on the SCAS-P (Nauta et al., 2004; Spence, 1998, 1997; Spence et al., 2003), we hypothesized 5 models: (1) one factor structure, (2) an uncorrelated 6-factor structure, (3) a correlated 6-factor structure, (4) one higher order factor with a correlated 6-factor structure, and (5) 5 correlated factors with generalized anxiety as a higher order factor. A 6-factor model with a single higher-order factor has been verified as the best model for children and adolescents (Spence, 1998, 1997; Spence et al., 2003). In the original study conducted on the development of the SCAS-P (Nauta et al., 2004), a 5-correlated factor structure, with generalized anxiety as one higher order factor, was supported. We used AMOS 20 to evaluate these models with an unweighted least-squares estimation (ULS) method. Because children who participated in this study were from a community sample, we expected that some of the questionnaire items would have positive kurtosis and skewness values (see Spence, Rapee, McDonald, & Ingram, 2001). As shown in Table 1, many SCAS-P items certainly showed positive kurtosis and skewness values in the current study. Although estimation methods, such as the maximum likelihood (ML) method, rely on assumptions of a multivariate normal distribution, the ULS is more appropriate for the present analysis (Toyoda, 2003). At first, 5 factor structures were examined by using mothers’ scores based on goodness of fit indices. We used the Goodness Fit Index (GFI), Adjusted Goodness Fit Index (AGFI), Root Mean Square Residual (RMR), Normed Fit Index (NFI), and Parsimonious Normed Fit Index (PNFI) for the evaluation of each model.
The first model was a single factor model (Model 1). In this model, all symptoms were predicted to load on a single factor, which was related to general anxiety vulnerability. The model hypothesized that anxiety symptoms in children (rated by their parents) were constructed as a single dimension rather than various subtypes of anxiety. Confirmatory factor analysis revealed that 15 items had a loading in excess of .40 on the single factor, 8 items had a loading lower than .35, and the remaining 15 items’ loadings were > .30. As shown in Table 2, although goodness of fit indices for the model were satisfactory, there was room of further examination.
The second model (Model 2) had 6 uncorrelated factors, which were consistent with anxiety disorder subtypes within the DSM-IV-TR (APA, 2000): separation anxiety disorder, social phobia, generalized anxiety disorder, panic attack and agoraphobia, obsessive-compulsive disorder, and specific phobia. In this model, childhood anxiety symptoms were experienced as distinct and independent clusters as reported by the parents. All items loaded on the hypothesized factors with factor loadings ranging from .23 to .75. Although only 6 items had loadings lower than 0.35 (as compared to Model 1), the goodness fit indices (GFI, AGFI, and NFI) were lower than .90. Thus, this model was not a good fit for the data.
The third model (Model 3) proposed that anxiety symptoms would cluster into 6 correlated dimensions. The model hypothesized that parents would report their children’s anxiety symptoms as multiple and intercorrelated clusters corresponding with the DSM. In this model, 33 items had a loading in excess of 0.35 on each hypothesized factor. Specifically, only 3 items, item 22 “When my child has a problems, (s)he feels shaky (GAD),” item 24 “My child has to think special thoughts (like numbers and words) to stop bad things from happening (OCD),” and item 25 “My child feels scared if (s)he has to travel in the car, or on a bus or train (Panic/Ag),” had lower factor loadings. Three goodness fit indices, namely GFI, AGFI, and NFI, were in excess of .90 and RMR was at its lowest value among all the models evaluated in this study. Thus, the 6 correlated factors model was used as the preferred model2. The factor loadings of each item are shown in Table 3.
The fourth model (Model 4), which had 6 correlated factors with one higher order factor, was in accordance with the previous anxiety symptoms model rated by child self-reports not only in the original samples (Spence, 1997, 1998) but also within the Japanese sample (Ishikawa et al., 2009). The higher-order model examined the degree to which the intercorrelation between factors could be explained by a single, second-order factor representing a general dimension of anxiety problems (Spence et al., 2003). Confirmatory factor analysis also revealed that only three items (items 22, 24, and 25) had a loading lower than .35 on the generalized anxiety disorder, obsessive-compulsive disorder, and panic attack and agoraphobia factors, respectively. As shown in Table 2, the goodness of fit indices were satisfactory.