Anxiety Disorders 17 (2003) 427446

A psychometric evaluation of the parent report form of the State-Trait Anxiety Inventory for ChildrenTrait Version$
Michael A. Southam-Gerowa,*, Ellen C. Flannery-Schroederb, Philip C. Kendallc
Department of Psychology, Virginia Commonwealth University, 808 W. Franklin Street, Box 842018, Richmond, VA 23284-2018, USA b Department of Social Sciences, University of the Sciences in Philadelphia, Philadelphia, PA, USA c Department of Psychology, Temple University, Philadelphia, PA, USA Received 11 January 2002; received in revised form 8 March 2002; accepted 25 March 2002
a

Abstract We examined the psychometric characteristics of the State-Trait Anxiety Inventory for ChildrenParent ReportTrait Version (STAIC-P-T) [Strauss, C. (1987). Modication of trait portion of State-Trait Anxiety Inventory for ChildrenParent Form. Gainesville, FL: University of Florida], a brief, parent report paper-and-pencil measure of child chronic anxiety, in a large clinic-referred sample. Internal consistency coefcients were high and retest reliability coefcients were in the moderate range. Convergent validity evidence was mixed in its support for the measure, with evidence most supportive within reporter and within parental dyad. Divergent validity evidence provided less support for the measure, but was largely consistent with past research. Regression analyses indicated that parent reports on the STAIC-P-T were not signicantly related to a parents own level of symptomatology. Overall, the study provides mixed support for the psychometrics of the STAIC-P-T. # 2002 Elsevier Science Inc. All rights reserved.
Keywords: Psychometric; Anxiety; Child; Assessment

$ The study was supported by a research grants MH 59087, MH 60653, and MH 44042 to Dr. Kendall from the National Institute of Mental Health. * Corresponding author. Tel.: 1-804-827-0585; fax: 1-804-828-2237. E-mail address: masouthamger@vcu.edu (M.A. Southam-Gerow).

0887-6185/02/$ see front matter # 2002 Elsevier Science Inc. All rights reserved. PII: S 0 8 8 7 - 6 1 8 5 ( 0 2 ) 0 0 2 2 3 - 2

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1. Introduction The amount of research directed toward anxiety disorders in children has increased signicantly over the past 10 years. The mounting body of research devoted to the topic may well reect the realization of the seriousness and debilitation associated with the disorders (e.g., Bell-Dolan & Wessler, 1994; Kendall et al., 1992; Silverman & Ginsburg, 1998). Anxiety disorders are among the most frequently reported category among children and adolescents (Anderson, 1994). Prevalence estimates range from 6 to 17%, with rates increasing slightly with age (e.g., Fergusson, Horwood, & Lynskey, 1993). Data indicate that anxiety disorders remain stable throughout childhood and adolescence in the absence of treatment and result in moderate to severe disruptions in the development of children (e.g., Silverman & Ginsburg, 1998). Thus, early detection of such disorders is critical. Numerous instruments are available to assess anxiety in childhood. Instruments include, but are not limited to, structured diagnostic interviews (e.g., Anxiety Disorders Interview Schedule for Children [ADIS; Silverman & Albano, 1996]; Schedule for Affective Disorders and Schizophrenia for School-Age ChildrenPresent and Lifetime Version [K-SADS-PL; Kaufman et al., 1997]; Child and Adolescent Psychiatric Assessment, [CAPA; Angold et al., 1995]) and child self-report measures of anxious symptomatology (e.g., State-Trait Anxiety Inventory for Children [STAIC; Spielberger, 1973]; Revised Childrens Manifest Anxiety Scale [RCMAS; Reynolds & Richmond, 1985]; Fear Survey Schedule for ChildrenRevised [FSSC-R; Ollendick, 1983]). More recently, the Multidimensional Anxiety Scale for Children (MASC; March, Parker, Sullivan, Stallings, & Conners, 1997) and the Screen for Child Anxiety-Related Emotional Disorders (SCARED; Birmaher et al., 1997) have been developed as child selfreport instruments. Few parent report measures assessing anxiety-specic symptomatology exist (the parent version of the SCARED is a recent notable exception). For example, the Child Behavior Checklist (CBCL; Achenbach, 1991a) includes an anxiety depression subscale; however, the scale focuses on negative affectivity in general and has considerably fewer anxiety-specic items compared to depressionspecic items. Some investigators (e.g., Silverman et al., 1999) have used a parent report form of the Revised Childrens Manifest Anxiety Scale (RCMASP); however, to date, no psychometric data have been reported. March and colleagues found that parent and child ratings on the MASC were generally poorly correlated, with concordance slightly better for symptoms more easily observed by parents (e.g., March & Parker, 1999; March et al., 1997). However, concordance was slightly greater for areas easily observable by parents. The parent version of the SCARED was moderately correlated with the child version (intraclass correlation coefficients :37.62), and both versions have been found to have good internal consistency (r :70.90) and retest reliability (r :60.90). In addition, both versions demonstrated adequate discriminant, convergent, and

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divergent validity (Birmaher et al., 1997). Only recently has data on parent-report measures of child anxiety begun to emerge.1 An important issue in measuring child anxiety concerns how one denes anxiety. Developers of the various rating scales have sought to measure anxiety in slightly different ways, relying on different conceptualization of anxiety. For example, some measures of child anxiety focus on particular aspects of anxiety, like specic fears (e.g., FSSC-R) or worries (see Silverman, LaGreca, & Wasserstein, 1995; Vasey, Crnic, & Carter, 1994). Others tap DSM anxiety disorder categories (e.g., SCARED). Still others measure specic characteristics or behaviors associated with anxiety such as anxiety sensitivity or anxiety-related somatic reactions (e.g., Child Anxiety Sensitivity Index [CASI]; Silverman, Fleisig, Rabian, & Peterson, 1991). Finally, some measures offer a multidimensional assessment of anxiety, encompassing many of the dimensions mentioned (e.g., fearfulness, worry; e.g., RCMAS; MASC). The issue of how to measure child anxiety is embedded in theoretical issues (e.g., What is anxiety?). The STAIC, from which the STAIC-P-T was adapted, includes an assessment of both trait (i.e., enduring characteristic) and state (i.e., situational, transitory) anxiety. However, the state-trait distinction has not received much empirical validation both types of anxiety have been found to vary in duration and across situations and contexts (Stallings & March, 1995). Even recent state-trait theorists have adopted a multidimensional approach (e.g., Endler, Parker, Bagby, & Cox, 1991). Another issue in the measurement of child anxiety (and child psychopathology in general) is that parents and youth often disagree about the psychological symptoms the youth is experiencing. For example, a majority of studies examining levels of child anxiety symptoms and diagnoses nd imperfect cross-informant overlap (e.g., DiBartolo, Albano, Barlow, & Heimberg, 1998; Frick, Silverthorn, & Evans, 1994). As a result, considerable debate exists regarding who is the more reliable reporter of childrens anxious symptomatologyparent or child. Some studies have suggested that children may be the best reporters on their own distress (e.g., Edelbrock, Costello, Dulcan, Conover, & Kala, 1986; Jensen, Traylor, Xenakis, & Davis, 1988) whereas others found that parents might more reliably report their childrens anxious distress (e.g., DiBartolo et al., 1998; Rapee, Barrett, Dadds, & Evans, 1994; Schniering, Hudson, & Rapee, 2000). The controversy over whose report is more reliable notwithstanding, few disagree that the use of parent reports in conjunction with child reports confers signicant advantages over an exclusive reliance on youth self-report. First, it is unclear how reliable the reports of younger youth (before age 10) are for subtle feeling states like worry, anxiety, and depression (e.g., Edelbrock, Costello, Dulcan, Kala, & Conover, 1985; Harris, 1993; Silverman & Eisen, 1992; but see Silverman & Rabian, 1995). Second, Schniering et al. (2000) reported a trend in which children had more difculty reporting on complex details such as the
1 Data for the present study were collected prior to the development of the MASC or SCARED. Their addition to the project would have been informative.

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duration and onset of symptoms. Similarly, Perez, Ascaso, Massons, and Chaparro (1998) found children to demonstrate difculties in thinking retrospectively and in answering questions that require the most meta-cognition (e.g., questions about internal feeling states). Third, because children almost never refer themselves for clinical treatment, ignoring the parents view seems clinically contraindicated. Finally, with only one reporter, it is not possible to evaluate concurrent validity. The relative dearth of data on parent report measures of childrens anxiety combined with research suggesting the importance of multiple informants makes a strong case for the need for a psychometrically sound parent report measure of child anxiety. Accordingly, the present investigation details the psychometric properties of the parent report form of Spielbergers State-Trait Anxiety Inventory for ChildrenTrait Version (STAIC-T; Spielberger, 1973), adapted by Strauss (1987; STAIC-P-T). To examine the psychometric properties of the STAIC-P-T, we looked at both reliability and validity data in a large sample drawn from an active research clinic treating childhood anxiety disorders. First, to inspect the measures reliability, we examined internal consistency and retest reliability of the measure. Reliability evidence was tested separately for maternal and paternal report. We examined concurrent and predictive (across 8 weeks) validity. Validity evidence was tested separately for maternal and paternal report. Some researchers have made use of teacher reports, as well as parent reports, of anxious distress; however, inclusion of the teachers view has been rare. Teacher reports may serve as fairly reliable and objective indices of childrens distress. Analyses were also conducted to examine the extent to which the STAIC-P-T correlated with measures of child externalizing symptomatology. Finally, because there is controversy about the extent to which a parents own symptomatology affects his/her report on child symptoms (Breslau, Davis, & Prabucki, 1988; Frick et al., 1994; Klein, 1991; Krain & Kendall, 2000; Renouf & Kovacs, 1994; Richters, 1992; Richters & Pellegrini, 1989; Tarullo, Richardson, Radke-Yarrow, & Martinez, 1995; Webster-Stratton, 1988), we conducted correlational and hierarchical multiple regression analyses to examine if maternal and paternal self-reports of internalizing symptoms were related to their report of their childrens anxiety symptoms on the STAIC-P-T.

2. Method 2.1. Participants Our sample (n 241; mean age 11:2 years; S:D: 1:6; range 7.515.7) was comprised of a clinically-referred group of youth who all met diagnostic criteria for one of several primary DSM-III-R (American Psychiatric Association, 1987) or DSM-IV (American Psychiatric Association, 1994) anxiety disorder

M.A. Southam-Gerow et al. / Anxiety Disorders 17 (2003) 427446 Table 1 Sample demographic variables Variable Gender (n 233) Female Male Family income (n 192) Below $20,000 $20,000$49,999 $50,000$80,000 Above $80,000 Ethnicity (n 233) Caucasian African-American Other Family conguration (n 231) Two-parent Nondual parent Differences in sample sizes across variables are due to missing data. n (%) 99 (42) 134 (58) 20 87 60 25 (10) (45) (31) (13)

431

193 (83) 24 (10) 16 (7) 172 (77) 52 (23)

diagnoses: separation anxiety disorder (SAD), overanxious disorder (OAD), generalized anxiety disorder (GAD), social phobia (SOP), and/or avoidant disorder (AVD) of youth. Demographic information for this sample is provided in Table 1. 2.2. Procedure Procedures for recruitment and evaluation of these youth are reported in detail elsewhere (e.g., Kendall, 1994; Kendall et al., 1997). All youth and their families were referred to an anxiety disorders clinic at Temple University and provided consent and assent to participate in a clinical trial at the time of the initial assessment. Children were randomly assigned to treatment or an 8-week waitlist control condition. Assessments were completed before (PRE1), immediately following (POST), and 1-year following treatment (FU) for the treated group. Waitlist participants were assessed before (PRE1) and immediately after (PRE2) the waiting period. All children in the waitlist condition were treated following the waiting period. 2.3. Measures 2.3.1. Diagnostic measures Anxiety Disorders Interview Schedule for ChildrenParent Version for DSMIII-R (Silverman, 1991) and ADIS for ChildrenParent and Child Versions for

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DSM-IV (Silverman & Albano, 1996). The ADIS-P and ADIS-C are structured diagnostic interviews administered to parents and children, respectively, to determine the presence of DSM-III-R and DSM-IV diagnoses in children and adolescents. Severity/impairment (i.e., How much does the problem interfere/ mess things up for you?) ratings for each diagnosis meeting criteria were also collected. Supportive reliability data have been reported for the DSM-III-R (ADIS-P: overall inter-rater kappa .67; Silverman & Eisen, 1992; Silverman & Rabian, 1995; ADIS-C: overall inter-rater kappa .76; Silverman & Eisen, 1992; Silverman & Rabian, 1995) and the DSM-IV versions (inter-rater kappas ranging from .65 to .88 for the ADIS-P and from .57 to .80 for the ADIS-C; Silverman, Saavedra, & Pina, 2001). 2.3.2. Youth self-report measures 2.3.2.1. State-Trait Anxiety Inventory for Children (STAIC). The widely used STAIC (Spielberger, 1973) includes two 20-item self-report scales that measure both enduring tendencies to experience anxiety (Trait form; STAIC-T) and temporal and situational variations (State form; STAIC-S). Retest reliability over a 6-week interval ranged between .65 and .71 for the trait form and .31 and .47 for the state form. Concerning concurrent validity, the trait version of the measure correlates .75 with the Childrens Manifest Anxiety Scale (Castaneda, McCandless, & Palermo, 1956) and .63 with the General Anxiety Scale for Children (Sarason, Davidson, Lighthall, Waite, & Ruebush, 1960). In the present sample, the STAIC-T correlated .72 with the RCMAS. Normative data are available (Spielberger, 1973). 2.3.2.2. Fear Survey Schedule for ChildrenRevised (FSSC-R). Ollendick (1983) revised the 80-item, ve-point scale (Scherer & Nakamura, 1968) to create a three-point scale assessing-specic fears in children, with eight fear categories including school, social, and physical fears. The scale has solid internal consistency (alpha coefcients in the range of .92), adequate retest reliability (Ollendick, 1983), and correlated highly with a measure of trait anxiety (STAICT; range .46.51). Normative data are available (Ollendick, King, & Frary, 1989; Ollendick, Matson, & Helsel, 1985). 2.3.2.3. Revised Childrens Manifest Anxiety Scale (RCMAS). Another widely used measure of a youths chronic (trait) anxiety, the scale consists of 37 items including a nine-item Lie scaleto which children respond Yes or No (Reynolds & Richmond, 1985). Several studies have demonstrated adequate retest reliability (Reynolds, 1981; Reynolds & Paget, 1983). Concurrent validity studies have shown signicant correlations with trait, but not state, anxiety as measured by the STAIC. This may indicate that the RCMAS measures chronic anxiety independent of state or situation. Additionally, some research demonstrates the RCMAS to have limited utility in differentiating between

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anxiety and other psychiatric diagnoses (e.g., Hoehn-Saric, Maisami, & Weigand, 1987). 2.3.3. Parent report measures 2.3.3.1. State-Trait Anxiety Inventory for ChildrenParent ReportTrait Version (STAIC-P-T). Strauss (1987) modied the trait version of the STAIC (Spielberger, 1973) to be used as a parent rating of a youths trait anxiety. The STAIC-P-T differs from the STAIC in that all questions are worded to describe the childs experience from the parents point of view (e.g., (s)he worries about making mistakes). The STAIC-P-T also includes an additional six questions that tap the parents report of several child anxiety-related physiological responses (e.g., jittery, headaches, dry mouth). 2.3.3.2. Child Behavior Checklist (CBCL). The CBCL is a widely used 118-item scale that assesses an array of behavioral problems. Five narrow-band subscales were included in our validity analyses: anxious-depression, somatic complaints, withdrawn behavior, aggressive behavior, and delinquent behavior. The CBCL has good retest reliability (r > :87 over 1 week, r > :62 over 1 year) and interparent agreement (r :65.76). Content and criterion-related validity have been adequately demonstrated as nearly all CBCL items as well as scale scores and clinical cut points on the scale scores discriminated between referred and nonreferred children. Construct validity has been assessed by the correlations between the CBCL scales and the closest counterpart scales of the Connors (1973) Parent Questionnaire (r :56.86) and the Quay and Peterson (1983) Revised Behavior Problem Checklist (r :52.88). Normative data are available for both clinical and nonclinical samples (Achenbach, 1991a). 2.3.3.3. State-Trait Anxiety Inventory (STAI). The STAI (Spielberger, Gorusch, & Lushene, 1970) is a widely used two-part, 40-item measure that assesses an adults own state and trait anxiety symptoms. Reliability, validity, and normative data support utility of the measure (e.g., Spielberger, 1973). Both the trait (STAIT) and state (STAI-S) versions were used in the current investigation. The measure was included to determine the relationship between parental anxiety symptoms (both acute and chronic) and parent report on child anxiety. 2.3.3.4. Beck Depression Inventory (BDI). A widely used 21-item scale, the BDI assesses an adults own depressive symptoms (Beck & Beamesderfer, 1974; Kendall, Hollon, Beck, Hammen, & Ingram, 1987). Coefcient alphas of the BDI average in the high .80s with clinical populations (Beck, Steer, & Garbin, 1988). Concurrent and construct validity has been established using a variety of psychological measures (Beck & Steer, 1987), and the measure has been shown to discriminate between depressed and nondepressed clinical patients (Steer, Beck, & Garrison, 1986).

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2.3.4. Teacher report measure 2.3.4.1. Teacher Report Form (TRF). The TRF parallels the parent version of the CBCL, providing a picture of the youths classroom functioning. Achenbach (1991b) has reported good psychometric characteristics for the TRF, including good retest reliability (r :90.92 over an interval of 15 days) and good discriminative validity. As with the CBCL, we included ve of the TRFs clinical scales in our validity analyses: anxious-depression, somatic complaints, withdrawn behavior, aggressive behavior, and delinquent behavior (Achenbach, 1991b).

3. Results 3.1. Descriptive statistics Descriptive statistics for all measures at PRE1 are found in Table 2. Signicant differences between maternal and paternal report are noted. Diagnoses for participating children are listed in Table 3. Comorbidity was common in the sample. The total number of parent report diagnoses averaged 2.7 (range 06; S:D: 1:2) and the total number of child report diagnoses averaged 1.6 (range 05; S:D: 1:3). 3.2. Analytic plan Reliability analyses and several validity analyses were conducted to examine the psychometric properties of the STAIC-P-T. We used data from mothers and fathers from four separate assessment points described before (i.e., pretreatment/prewaitlist [PRE1]; postwaitlistan 8-week period [PRE2]; posttreatmenttreatment lasted 1620 sessions, approximately 5 months [POST]; and 1-year follow-up [FU]). Order of analyses was as follows: (a) internal consistency (using Cronbachs alpha); (b) retest reliability; (c) concurrent validity; (d) predictive validity; (e) discriminant validity; and (f) Parental Psychopathology Regression Analyses. 3.3. Reliability analyses 3.3.1. Internal consistency We examined internal consistency reliability using Cronbachs alpha statistic. Internal consistency was examined separately at each of the four time points and for maternal and paternal report separately: (a) Maternal report (PRE1: n 233; alpha :84; PRE2: n 72; alpha :87; POST: n 162; alpha :91; FU: n 118; alpha :90); (b) Paternal report (PRE1: n 135; alpha :88; PRE2: n 46; alpha :90; POST: n 100; alpha :90; FU: n 67; alpha :91). All of these statistics suggest very high internal reliability of the measure.

M.A. Southam-Gerow et al. / Anxiety Disorders 17 (2003) 427446 Table 2 Descriptive statistics of measures M Maternal report STAIC-P-T CBCLwithdrawn CBCLsomatic complaints CBCLanxiety/depression CBCLdelinquent CBCLaggressive STAI-T STAI-S BDI Paternal report STAIC-P-T CBCLwithdrawn CBCLsomatic complaints CBCLanxiety/depression CBCLdelinquent CBCLaggressive STAI-T STAI-S BDI Child self-report RCMAS STAI-T STAI-S FSSC-R Teacher report TRFwithdrawn TRFsomatic complaints TRFanxiety/depression TRFdelinquent TRFaggressive
*

435

S.D. 7.63 10.03 9.70 9.50 5.97 7.80 9.98 12.06 6.66 8.69 9.65 10.00 9.31 4.94 6.38 9.06 11.43 5.24 10.27 12.85 11.75 26.36 10.13 10.36 9.96 5.26 6.06

53.18* 65.19 66.65* 70.62* 54.11 56.42 39.91 37.90 8.26 40.47* 63.26 63.04* 66.65* 53.26 54.56 37.60 38.11 6.80 52.79 51.54 53.67 133.60 61.30 58.07 64.12 53.26 54.25

P < :01.

3.3.1.1. Retest reliability. Intraclass correlation coefcients were calculated to provide an estimate of retest reliability. Separate ICCs were conducted for the following time-spans: (a) PRE1 to PRE2: 8 weeks and (b) POST to FU: 1 year. Treatment occurred between the PRE2 assessment and the POST assessment and thus no ICC was calculated for that time-span. We conducted each analysis separately for maternal and paternal report. Both single-case and mean ICCs are reorted. In general, the mean ICC is usually larger than the single-case (Shrout & Fleiss, 1979). For maternal report, ICCs were (a) PRE to PRE2 (n 72; single-case ICC :55; mean ICC :71) and (b) POST to FU (n 113; single-case ICC :61; mean ICC :76). For paternal report, the ICCs were (a) PRE to PRE2 (n 43; single-case ICC :61; mean ICC :75) and (b) POST to FU

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Table 3 Positive DSM diagnostic status for youth, by reporter Diagnoses OAD SAD SOP AVD Simple phobia Obsessive-compulsive disorder Panic disorder Major depressive disorder Dysthymic disorder Attention decit hyperactivity disorder Oppositional deant disorder Conduct disorder Parent report (%) 83 40 28 15 46 1 2 3 5 14 10 1 Youth report (%) 42 36 1 7 36 1 1 2 2 5 0 0

(n 62; single-case ICC :51; mean ICC :68). Using Landis and Kochs (1977) standards, two of the single-case coefcients are in the acceptable but improvable range (above .40) and two are in the satisfactory range (above .60). All four of the mean ICCs are in the satisfactory range. 3.4. Validity analyses 3.4.1. Concurrent To examine the extent to which scores on the STAIC-P-T were concurrently related to other measures of childhood anxiety, Pearson correlational analyses were employed. Four sets of variables were used for these analyses: (a) maternal report measures of child internalizing psychopathology (i.e., CBCL anxiety depression, CBCL somatic complaints, CBCL withdrawn behavior, STAIC-P-T); (b) paternal report measures of child internalizing psychopathology (i.e., CBCL anxietydepression, CBCL somatic complaints, CBCL withdrawn behavior, STAIC-P-T); (c) child report measures of child anxiety (i.e., FSSC-R, RCMAS, STAIC-T, STAIC-S); and (d) teacher report measures of child internalizing psychopathology (i.e., TRF anxietydepression, TRF somatic complaints, TRF withdrawn behavior). For each set of tests, we used a modied Bonferroni procedure to adjust the alpha level. Instead of adjusting our alpha level for each set of tests, we averaged the alpha levels we would have used across each test and applied that mean alpha level across all tests in the study. We used this procedure to permit the use of an equivalent standard across all tests while protecting against Type I Error. Hence, alpha was set at .017. Separate correlational analyses were conducted for maternal and paternal report; only PRE1 data were used for these analyses. Table 4 contains the results of these analyses. Overall, results suggested four conclusions. First, correlations were highest within reporter (e.g., maternal report on the STAIC-P-T correlated highest with maternal report on other measures). Second, correlations between parents reports

M.A. Southam-Gerow et al. / Anxiety Disorders 17 (2003) 427446 Table 4 Concurrent and predictive validity correlations Mother STAIC-P Maternal report STAIC-P-T Concurrent Predictive CBCLanxiety/depression Concurrent Predictive CBCLwithdrawn Concurrent Predictive CBCLsomatic complaints Concurrent Predictive Paternal report STAIC-P-T Concurrent Predictive CBCLanxiety/depression Concurrent Predictive CBCLwithdrawn Concurrent Predictive CBCLsomatic complaints Concurrent Predictive Child self-report RCMAS Concurrent Predictive STAI-T Concurrent Predictive STAI-S Concurrent Predictive FSSC-R Concurrent Predictive Teacher report TRFanxiety/depression Concurrent Predictive TRFwithdrawn Concurrent Predictive TRFsomatic complaints Concurrent Predictive Numbers in parentheses are sample sizes. * P < :017.

437

Father STAIC-P

.61 (72)* .50 (233)* .50 (74)* .21 (233)* .23 (74) .37 (233)* .42 (74)*

.60 (135)* .54 (45)* .46 (135)* .38 (45)* .21 (135)* .15 (45) .42 (135)* .33 (45)

.60 (135)* .49 (46)* .45 (136)* .41 (47)* .07 (136) .04 (47) .34 (136)* .47 (47)*

.61 (43)* .65 (131)* .42 (42)* .27* (131) .04 (42) .53 (131)* .49 (42)*

.19 (232)* .22 (71) .21 (231)* .13 (71) .15 (229) .09 (72) .11 (225) .02 (72) .02 (216) .04 (67) .06 (216) .20 (67) .15 (216) .09 (67)

.10 (135) .18 (45) .13 (134) .16 (44) .25 (132)* .08 (45) .06 (134) .01 (45)

.09 (129) .08 (42) .06 (129) .01 (42) .08 (129) .15 (42)

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were moderately high. Third, child reports correlated rather poorly with the STAIC-P-T. Fourth, teacher reports were essentially uncorrelated with the STAIC-P-T. 3.4.2. Predictive Predictive validity analyses were conducted in a manner similar to the concurrent analyses, with maternal report, paternal report, child self-report, and teacher report variables at PRE2 (postwaitlist but prior to treatment) used as the criterion variables. Separate correlational analyses were conducted for maternal and paternal report. Table 4 provides the results. Results were consistent with the concurrent validity evidence, suggesting that the STAIC-P-T correlated most highly within reporter and next with the other parents report. Correlations of the STAIC-P-T with measures of reporters outside of the parental dyad were uniformly low. 3.4.3. Discriminant To examine discriminant validity, Pearson correlational analyses were employed. Three sets of variables were used for these analyses: (a) maternal report measures of child externalizing psychopathology (i.e., CBCL aggressive and delinquent behavior scales); (b) paternal report measures of child externalizing psychopathology (i.e., CBCL aggressive and delinquent behavior scales); and (c) teacher report measures of child externalizing psychopathology (i.e., TRF aggressive and delinquent behavior scales). Separate correlational analyses were conducted for maternal and paternal report. Table 5 provides the results. Overall,

Table 5 Discriminant validity correlations Mother STAIC-P Maternal report CBCLaggressive CBCLdelinquent behavior STAI-Trait STAI-State BDI Paternal report CBCLaggressive CBCLdelinquent behavior STAI-Trait STAI-State BDI Teacher report TRFaggressive TRFdelinquent behavior Numbers in parentheses are sample sizes. * P < :017. .21 .16 .12 .09 .20 .19 .01 .02 .04 .01 (233)* (233)* (208) (208) (208)* (136)* (136) (163) (154) (164) Father STAIC-P .14 .03 .04 .02 .05 .31 .09 .11 .09 .14 (135) (135) (133) (134) (134) (131)* (131) (133) (125) (134)

.14 (216) .08 (216)

.05 (129) .07 (129)

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results indicated that the STAIC-P-T correlated in the low to moderate range with measures that tap externalizing behavior problems. Correlations were highest between the STAIC-P-T and the CBCL Aggressive behavior subscale, ranging from .19 to .31. These correlations were of a similar magnitude as those between the STAIC-P-T and child self-report measures of anxiety. 3.4.4. Parental psychopathology analyses To examine the extent to which a parents own level of psychopathology inuenced his/her report on the STAIC-P-T, we conducted two sets of analyses. First, we examined correlations between measures of parental psychopathology and the STAIC-P-T. Results from the correlational analyses are found in Table 5. We followed the correlational analyses with hierarchical multiple regression analyses to determine the amount of variance accounted for in the STAIC-P-T by self-reported parental psychopathology. First, we chose to enter child age and child gender in one step as organismic variables that could potentially inuence STAIC-P-T scores. Next, we entered the STAI-Trait and BDI scores as predictor variables. We also chose to enter two additional variables separately (the STAICP-T score of the other parent and the child report STAIC-T) to assess the predictive power of the reports of others in the home for STAIC-P-T scores. In sum, two hierarchical regression analyses were conducted, one predicting the maternal STAIC-P-T (see Table 6) and the second predicting the paternal STAIC-P-T (see Table 7). The order of entry into the regression analyses was as follows: (a) age and gender; (b) parental STAI-Trait; (c) parental BDI; (d) other parents STAIC-P-T; and (e) youth STAIC-T. The maternal STAIC-P-T results suggested that most of the variance (33%) in the maternal STAIC-P-T could be accounted for by paternal report of youth anxiety (STAIC-P-T). Only a small portion of variance was accounted for maternal self-report of anxiety and depression symptoms (2.2%). For the prediction of paternal report STAIC-PT, maternal report of youth anxiety accounted for 35% of the variance. Similar to
Table 6 Hierarchical multiple regression ndings for prediction of maternal STAIC-P-T scores from several measures (n 132) Step # (1) (2) (3) (4) (5) Age and gender M-STAI-T M-BDI P-STAIC-P-T STAIC-T R2 .01 .01 .04 .37 .41 Adjusted R2 0 0 .01 .35 .38 R2 change .01 .01 .02 .33 .04 F change .89 .05 2.96 66.74** 7.82* Standardized beta .12/.02 .02 .21 .60** .20*

M-BDI, Beck Depression Inventory-Maternal Self-Report; M-STAI-T, Maternal Self-Report-Trait Version; P-STAIC-P-T, State-Trait Anxiety Inventory for ChildrenPaternal Report on Child Trait Anxiety; STAIC-T, State-Trait Anxiety Inventory for Children-Trait Version. * P < :01. ** P < :001.

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Table 7 Hierarchical multiple regression ndings for prediction of paternal STAIC-P-T scores from several measures (n 131) Step # (1) (2) (3) (4) (5) Age and gender P-STAI-T P-BDI M-STAIC-P-T STAIC-T R2 .07 .08 .09 .43 .43 Adjusted R2 .05 .06 .06 .41 .40 R2 change .07 .02 0 .35 0 F change 4.60 2.06 .49 76.23* 0 Standardized beta .21/.15 .07 .09 .59* 0

P-BDI, Beck Depression Inventory-Paternal Self-Report; P-STAI-T, State-Trait Anxiety Inventory, Paternal Self-Report-Trait Version; M-STAIC-P-T, State-Trait Anxiety Inventory for Children Maternal Report on Child Trait Anxiety; STAIC-T, State-Trait Anxiety Inventory for Children-Trait Version. * P < :001.

the maternal STAIC-P-T analyses, paternal self-report of anxiety and depression symptoms accounted for less than 2% of the variance. These ndings strengthen the validity of the measure and do not support the notion that the parent selfreported psychopathology accounts for parental report of youth psychopathology.

4. Discussion The current study examined the psychometric properties of a parent report version of Spielbergers STAIC (Spielberger, 1973), the STAIC-P-T (adapted by Strauss, 1987). Results indicated the measure possesses high internal consistency and acceptable to satisfactory retest reliability (Landis & Koch, 1977). Concurrent and predictive validity evidence was mixed, with the STAIC-P-T correlating highest within reporter and with the other parents report. Correlations with child self-report were low (all below .25 and most below .20) whereas correlations with teacher report were essentially zero. Discriminant validity evidence offered little support for the measure, and source effects most parsimoniously explained the validity evidence. Finally, results of the regression analyses suggest that mother and fathers own self-reported levels of internalizing psychopathology did not predict their report on the measure. Overall, the results suggest only modest support for the use of the STAIC-P-T as a measure of childhood anxiety. Furthermore, because most current models of childhood anxiety emphasize multidimensional denitions of the construct, the best advice to researchers seeking a parent report measure of childhood anxiety may be to develop a new one based on newer child self-report measures of child anxiety like the MASC (March et al., 1997) or the SCARED (Birmaher et al., 1997). Internal consistency and retest reliability ndings offer a mixed picture of the measures psychometric characteristics. Cronbachs alpha coefcients were uniformly high, suggesting that the scale possesses very high internal consistency. Whether this supports the use of the measure depends in large part on how one

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denes the construct of anxiety. Measurement of child anxiety has been diverse, with some instruments tapping unidimensional aspects of anxious experience (e.g., specic fears; FSSC-R) whereas other instruments assess child anxiety as a multidimensional construct. If anxiety is viewed as a unidimensional construct, then the present internal consistency results are favorable. However, if anxiety is dened as multidimensional, then the results may be viewed less favorably. Either way, the high statistics, .90 or higher in ve of eight cases, suggest signicant item redundancy. Retest reliability results were moderately favorable, with ICCs in the acceptable to satisfactory range (Landis & Koch, 1977). The short retest period (i.e., 8 weeks) afforded a reasonable possibility for higher stability statistics. Other measures of childhood symptomatology have achieved better results (e.g., Achenbach, 1991a; March et al., 1997). Validity ndings offer mixed support for the use of the measure. First, source effects explain many of the signicant ndings. Within reporter, the STAIC-P-T correlates highly with measures of both similar (e.g., anxietydepression and somatic problems) and disparate (e.g., aggressive behavior) constructs. On the positive side, magnitude of correlations was higher for the measures tapping similar constructs. Still, the high rs within reporter for the discriminant measures represent an unfavorable result. The best validity evidence for the measure is within the parental dyad. Scores on the STAIC-P-T were highly correlated with the other parents report on the childs internalizing symptoms; the majority of rs exceeded .50. Validity coefcients for reporters outside of the parental dyad (i.e., child self-report and teacher report) were far less encouraging, with only a small number of the correlations reaching statistical signicance (3 out of 28) and all correlations below .26. Indeed, many of the discriminant validity coefcients (all parent report) were larger than the correlations for the child self-report measures and teacher report measures, underscoring the issue of source effects. These less favorable ndings for the relations between the STAIC-P-T and the youth self-report (and teacher report) measures recall the ubiquitous nding of low correspondence between parent and youth report of youth psychopathology symptoms. Research has consistently found that correlations between parent and youth reports range from .15 to .35 (e.g., Achenbach, McConaughy, & Howell, 1987; Edelbrock et al., 1986; Garber, Van Slyke, & Walker, 1998; Klein, 1991; Wachtel, Rodrigue, Geffken, Graham-Pole, & Turner, 1994). Better parentyouth agreement is associated with externalizing and/or more observable behaviors (e.g., conduct problems, drug abuse; see Achenbach et al., 1987; Edelbrock et al., 1986; Verhulst & van der Ende, 1991). Thus, our ndings concerning relation of parent report of youth anxiety (i.e., STAIC-P-T) and youth self-report of anxiety are consistent with previous work. A similar statement can be made concerning the low correlations between teacher ratings and the STAIC-P-T (Achenbach et al., 1987). The discriminant validity evidence warrants additional consideration. As noted before, magnitudes of the discriminant validity correlations were generally lower than the concurrent and predictive correlations, particularly considering the

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parent report correlations. Thus, although measures of nonanxiety-related constructs were signicantly correlated with the STAIC-P-T, coefcients were generally not as extreme as those of the anxiety-related measures. Second, magnitude of the correlations among externalizing scales and the STAIC-P-T are similar to those found with another parent report measure of child psychopathology, the CBCL. For instance, Achenbach (1991a) has reported correlations between internalizing and externalizing broad-band scales of the CBCL in the range of .56.63 (depending on age and gender). Among the several narrow-band scales comprising the internalizing and externalizing broad-band scales, Achenbach (1991a) reported correlations in the range of .16.54. Third, because our sample was clinic-referred and comorbidity was common, it was not a pure anxiety sample and the discriminant validity evidence is not a good estimate of the measures specicity. Finally, correlations of the STAIC-P-T with the CBCL delinquent behavior scale (items include Steals and Lies and cheats) were lower than those with the CBCL aggressive behavior scale (items include Argues and Stubborn), a fact that conforms to the clinical presentation of childhood anxiety disorders. Deant behaviors may be somewhat common in children with anxiety disorders; anxious children often ght with parents in an effort to avoid feared situations. However, more serious antisocial behaviors are more uncharacteristic of anxious children. Parental reports on the STAIC-P-T were not related to the parents own levels of psychopathology. Given the current controversy in the eld about the accuracy of parental reports, this nding bolsters the psychometric prole of the measure. Some work has suggested that parents with psychopathology over-report symptoms in their children (e.g., depressiondistortion bias; see Breslau et al., 1988; Frick et al., 1994; Klein, 1991; Renouf & Kovacs, 1994; Webster-Stratton, 1988). However, Richters (1992), among others, has suggested that the research used to support the distortion hypothesis is awed. In fact, there is a body of work suggesting the possibility that depressed mothers (for example) may actually be more sensitive or more accurate reporters of their childrens symptoms (e.g., Richters & Pellegrini, 1989; Tarullo et al., 1995). Controversy also exists among child anxiety researchers as to the relative validity of child versus parent reports of child anxiety symptoms (e.g., Frick et al., 1994; Schniering et al., 2000). Though this evidence does not address the controversy as to whose report is more accurate, it does suggest that STAIC-P-T scores are not well predicted by a parents own level of symptomatology. We should note that mean scores on the parental anxiety and depression measures in our sample were not in the clinical range. It is possible that a sample with parents reporting clinical levels of depression or anxiety would yield different results. The present study did not directly address the more general issues of measurement in the area of childhood anxiety (e.g., state-trait and multidimensional denitions of anxiety). Although the STAIC-P-T is clearly aligned with the state-trait approach, its modest psychometric performance in the current study does not necessarily undermine the model. However, given the measures

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unexceptional psychometric prole in this study, it is reasonable to consider use or development of a parent report measure of child anxiety using a multidimensional model. Future work could consider the relative merits of measurement of child anxiety based on the two models using the reports of parents, children, teachers, and clinicians. Although the present study has several strengths (e.g., large sample, multiple measures from multiple reporters), there are caveats to consider. First, our sample was a clinic-referred one. Findings should be replicated with nonclinical samples. In addition, the current project was not able measure the diagnostic sensitivity of the STAIC-P-T. Because all youth in our sample met criteria for at least one anxiety disorder diagnosis, we could not examine the utility of various cut scores for identifying diagnosed cases (e.g., ROC analyses). This issue could be addressed by a larger community sample. Finally, our sample did not possess adequate ethnic diversity to assess the measures psychometrics with other than European-American youth.

Acknowledgments We are grateful to our colleagues in the CAADC for their supportive involvement. We also extend our thanks to Serena Ashmore-Callahan, Aude Henin, Melissa J. Warman, Brian C. Chu, and Muniya Choudhury for their careful work with the data sets. Finally, we express gratitude to participating youth and their families in Pennsylvania, New Jersey, and Delaware.

References
Achenbach, T. M. (1991a). Manual for the Child Behavior Checklists/418 and 1991 Prole. Burlington, VT: University of Vermont. Achenbach, T. M. (1991b). Manual for the Teacher Report Form and 1991 Prole. Burlington, VT: University of Vermont. Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specicity. Psychological Bulletin, 101, 213232. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: Author. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Anderson, J. C. (1994). Epidemiology. In: T. H. Ollendick, N. J. King, & W. Yule (Eds.), International handbook of phobic and anxiety disorders in children and adolescents (pp. 293 315). New York: Plenum Press. Angold, A., Prendergast, M., Cox, A., Harrington, R., Simonoff, E., & Rutter, M. (1995). The Child and Adolescent Psychiatric Assessment (CAPA). Psychological Medicine, 25, 739753. Beck, A. T., & Beamesderfer, A. (1974). Assessment of depression: the Depression Inventory. In: P. Pichot (Ed.), Psychological measurement in psychopharmacology (pp. 151169). Paris, France: Karger, Basel.

444

M.A. Southam-Gerow et al. / Anxiety Disorders 17 (2003) 427446

Beck, A. T., & Steer, R. A. (1987). Manual for the Beck Depression Inventory. San Antonio, TX: The Psychological Corporation. Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: twenty-ve years of evaluation. Clinical Psychology Review, 8, 77100. Bell-Dolan, D., & Wessler, A. E. (1994). Attributional style of anxious children: extensions from cognitive theory and research on adult anxiety. Journal of Anxiety Disorders, 8, 7996. Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997). The Screen for Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 545553. Breslau, N., Davis, G. C., & Prabucki, K. (1988). Depressed mothers as informants in family history research: are they accurate? Psychiatry Research, 24, 345349. Castaneda, A., McCandless, B. R., & Palermo, D. S. (1956). The Childrens Form of the Manifest Anxiety Scale. Child Development, 27, 317326. Connors, C. K. (1973). Rating scales for use in drug studies with children. Psychopharmacology bulletin: pharmacotherapy with children. Washington, DC: US Government Printing Ofce. Edelbrock, C., Costello, A. J., Dulcan, M. K., Conover, N. C., & Kala, R. (1986). Parentchild agreement on child psychiatric symptoms assessed via structured interview. Journal of Child Psychology and Psychiatry, 27, 181190. Edelbrock, C., Costello, A. J., Dulcan, M. K., Kala, R., & Conover, N. C. (1985). Age differences in the reliability of the psychiatric interview of the child. Child Development, 56, 265275. Endler, N. S., Parker, J. D. A., Bagby, R. M., & Cox, B. J. (1991). Multidimensionality of state and trait anxiety: factor structure of the Endler Multidimensional Anxiety Scales. Journal of Personality and Social Psychology, 60, 919926. DiBartolo, P. M., Albano, A. M., Barlow, D. H., & Heimberg, R. G. (1998). Cross-informant agreement in the assessment of social phobia in youth. Journal of Abnormal Child Psychology, 26, 213220. Fergusson, D. M., Horwood, L. J., & Lynskey, M. T. (1993). Prevalence and comorbidity of DSM-IIIR diagnoses in a birth cohort of 15-year-olds. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 11271134. Frick, P. J., Silverthorn, P., & Evans, C. (1994). Assessment of childhood anxiety using structured interviews: patterns of agreement among informants and association with maternal anxiety. Psychological Assessment, 6, 372379. Garber, J., Van Slyke, D. A., & Walker, L. S. (1998). Concordance between mothers and childrens reports of somatic and emotional symptoms in patients with recurrent abdominal pain or emotional disorders. Journal of Abnormal Child Psychology, 26, 381391. Harris, P. L. (1993). Understanding emotion. In: M. Lewis & J. M. Haviland (Eds.), Handbook of emotions (pp. 237246). New York: Guilford Press. Hoehn-Saric, E., Maisami, M., & Weigand, D. (1987). Measurement of anxiety in children and adolescents using semi-structured interviews. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 541545. Jensen, P. S., Traylor, J., Xenakis, S. N., & Davis, H. (1988). Child psychopathology rating scales and interrater agreement: I. Parents gender and psychiatric symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 442450. Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., Williamson, D., & Ryan, N. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of American Academy of Child and Adolescent Psychiatry, 36, 980988. Kendall, P. C. (1994). Treating anxiety disorders in youth: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100110. Kendall, P. C., Chansky, T. E., Kane, M. T., Kim, R. S., Kortlander, E., Ronan, K. R., Sessa, F. M., & Siqueland, L. (1992). Anxiety disorders in youth: cognitive-behavioral interventions. Needham Heights, MA: Allyn & Bacon.

M.A. Southam-Gerow et al. / Anxiety Disorders 17 (2003) 427446

445

Kendall, P. C., Flannery-Schroeder, E. C., Panichelli-Mindel, S. P., Southam-Gerow, M. A., Henin, A., & Warman, M. J. (1997). Treating anxiety disorders in youth: a second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65, 366380. Kendall, P. C., Hollon, S., Beck, A., Hammen, C., & Ingram, R. (1987). Recommendations regarding the Beck Depression Inventory. Cognitive Therapy and Research, 11, 289299. Klein, R. G. (1991). Parentchild agreement in clinical assessment of anxiety and other psychopathology: a review. Journal of Anxiety Disorders, 5, 187198. Krain, A. L., & Kendall, P. C. (2000). The role of parental emotional distress in parent report of child anxiety. Journal of Clinical Child Psychology. Landis, J., & Koch, G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159174. March, J. S., & Parker, J. D. A. (1999). The Multidimensional Anxiety Scale for Children (MASC). In: M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (pp. 299322). Mahwah, NJ: Erlbaum. March, J. S., Parker, J. D. A., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 554565. Ollendick, T. (1983). Reliability and validity of the Revised Fear Survey Schedule for Children. Behaviour Research and Therapy, 21, 685692. Ollendick, T., King, N., & Frary, R. (1989). Fears in children and adolescents: reliability and generalizability across gender, age and nationality, age and nationality. Behaviour Research and Therapy, 27, 1926. Ollendick, T., Matson, J., & Helsel, W. (1985). Fears in children and adolescents: normative data. Behaviour Research and Therapy, 23, 465467. Perez, R. G., Ascaso, L. E., Massons, J. M. D., & Chaparro, N. D. O. (1998). Characteristics of the subject and interview inuencing the testretest reliability of the Diagnostic Interview for Children and Adolescents-Revised. Journal of Child Psychology and Psychiatry and Allied Disciplines, 39, 963972. Quay, H. C., & Peterson, D. R. (1983). Interim manual for the Revised Behavior Problem Checklist. Coral Gables, FL: University of Miami, Applied Social Sciences. Rapee, R. M., Barrett, P. M., Dadds, M. R., & Evans, L. (1994). Reliability of the DSM-III-R childhood anxiety disorders using structured interview: interrater and parentchild agreement. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 984992. Renouf, A. G., & Kovacs, M. (1994). Concordance between mothers reports and childrens selfreports of depressive symptoms: a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 208216. Reynolds, C. R. (1981). Long-term stability of scores on the Revised Childrens Manifest Anxiety Scale. Perceptual and Motor Skills, 53, 702. Reynolds, C. R., & Paget, K. D. (1983). National normative and reliability data for the Revised Childrens Manifest Anxiety Scale. School Psychology Review, 12, 324336. Reynolds, C. R., & Richmond, B. O. (1985). Revised Childrens Manifest Anxiety Scale (RCMAS): manual. Los Angeles: Western Psychological Services. Richters, J. E. (1992). Depressed mothers as informants about their children: a critical review of the evidence for distortion. Psychological Bulletin, 112, 485499. Richters, J. E., & Pellegrini, D. (1989). Depressed mothers judgments about their children: an examination of the depressiondistortion hypothesis. Child Development, 60, 10681075. Sarason, S. B., Davidson, K. S., Lighthall, F. F., Waite, R. R., & Ruebush, B. K. (1960). Anxiety in elementary school children. New York: Wiley. Scherer, M., & Nakamura, C. (1968). Fear Survey Schedule for Children Factoranalytic comparison. Behaviour Research and Therapy, 6, 173182. Schniering, C. A., Hudson, J. L., & Rapee, R. M. (2000). Issues in the diagnosis and assessment of anxiety disorders in children and adolescents. Clinical Psychology Review, 20, 453478.

446

M.A. Southam-Gerow et al. / Anxiety Disorders 17 (2003) 427446

Shrout, P., & Fleiss, J. (1979). Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin, 86, 420428. Silverman, W. K. (1991). Anxiety Disorders Interview Schedule for Children. Albany, NY: Graywind Publications. Silverman, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV: Child Version. San Antonio, TX: Psychological Corporation. Silverman, W. K., & Eisen, A. R. (1992). Age difference in the reliability of parent and child reports of child anxious symptomatology using a structured interview. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 117124. Silverman, W. K., Fleisig, W., Rabian, B., & Peterson, R. A. (1991). Child Anxiety Sensitivity Index. Journal of Clinical Child Psychology, 20, 162168. Silverman, W. K., & Ginsburg, G. S. (1998). Anxiety disorders. In: T. H. Ollendick & M. Hersen (Eds.), Handbook of child psychopathology(3rd ed., pp. 239268). New York: Plenum Press. Silverman, W. K., Kurtines, W. M., Ginsburg, G. S., Weems, C. F., White-Lumpkin, P., & HicksCarmichael, D. (1999). Treating anxiety disorders in children with group cognitive-behavior therapy: a randomized clinical trial. Journal of Consulting and Clinical Psychology, 67, 9951003. Silverman, W. K., LaGreca, A. M., & Wasserstein, S. (1995). What do children worry about? Worries and their relation to anxiety. Child Development, 66, 671686. Silverman, W. K., & Rabian, B. (1995). Testretest reliability of the DSM-III-R childhood anxiety disorders symptoms using the Anxiety Disorders Interview Schedule for Children. Journal of Anxiety Disorders, 9, 139150. Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Testretest reliability of Anxiety Symptoms and Diagnosis using the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Version (ADIS for DSM-IV:C/P). Journal of the American Academy of Child and Adolescent Psychiatry, 40, 937944. Spielberger, C. (1973). Manual for the State-Trait Anxiety Inventory for Children. Palo Alto, CA: Consulting Psychologists Press. Spielberger, C., Gorusch, R., & Lushene, R. (1970). STAI manual. Palo Alto, CA: Consulting Psychologists Press. Stallings, P., & March, J. S. (1995). Assessment. In: J. March (Ed.), Anxiety disorders in children and adolescents (pp. 125147). New York: Guilford Press. Steer, R. A., Beck, A. T., & Garrison, B. (1986). Applications of the Beck Depression Inventory. In: N. Sartorius & T. A. Ban (Eds.), Assessment of depression (pp. 121142). New York: Springer. Strauss, C. (1987). Modication of trait portion of State-Trait Anxiety Inventory for ChildrenParent Form. Available from author. Gainesville, FL: University of Florida. Tarullo, L. B., Richardson, D. T., Radke-Yarrow, M., & Martinez, P. E. (1995). Multiple sources in child diagnosis: parentchild concordance in affectively ill and well families. Journal of Clinical Child Psychology, 24, 173183. Vasey, M. W., Crnic, K. A., & Carter, W. G. (1994). Worry in childhood: a developmental perspective. Cognitive Therapy and Research, 18, 529549. Verhulst, F. C., & van der Ende, J. (1991). Assessment of child psychopathology: relationships between different methods, different informants, and clinical judgments of severity. Acta Psychiatrica Scandinavia, 84, 155159. Wachtel, J., Rodrigue, J. R., Geffken, G. R., Graham-Pole, J., & Turner, C. (1994). Children awaiting invasive medical procedures: do children and their mothers agree on childs level of anxiety? Journal of Pediatric Psychology, 19, 723735. Webster-Stratton, C. (1988). Mothers and fathers perceptions of child deviance: roles of parent and child behaviors and parent adjustment. Journal of Consulting and Clinical Psychology, 56, 909915.