Running head: A parental report of children’s anxiety symptoms in Japan
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: ishinn@mail.doshisha.ac.jp
A parental report of children’s anxiety symptoms
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
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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
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
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A parental report of children’s anxiety symptoms
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,
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A parental report of children’s anxiety symptoms
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
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A parental report of children’s anxiety symptoms
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
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A parental report of children’s anxiety symptoms
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.
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A parental report of children’s anxiety symptoms
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
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A parental report of children’s anxiety symptoms
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
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A parental report of children’s anxiety symptoms
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
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A parental report of children’s anxiety symptoms
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
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A parental report of children’s anxiety symptoms
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
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A parental report of children’s anxiety symptoms
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.
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A parental report of children’s anxiety symptoms
In the original studies validating the SCAS-P, 5 correlated factors and generalized anxiety
as one higher order factor was also evaluated as another plausible model (Nauta et al., 2004).
We also examined this model as the fifth model (Model 5). As shown in Table 2, the goodness
of fit indices were similar to a single factor model. Thus, we concluded that the model did not
adequately describe the data as compared to the original sample.
There were relatively small differences among goodness of fit indices in Model 3 and
Model 4. In addition, a model that has fewer constraints tends to show higher goodness of fit
indices. Thus, in order to confirm the robustness of Model 3 and Model 4, a cross validation
was examined by randomly selecting two samples from the original data. There were no
significant differences between the first (n = 288) and second samples (n = 280) in terms of
child age, child gender, mother age, and the mean score on the SCAS-P, t (566) = 1.67; χ2 (1)
= .45; t (566) = 0.17; and F (1, 566) = 0.53, respectively. In terms of the first sample, there were
no clear differences between the two models: GFI = .948 vs. .947, AGFI = .941 vs. .940, NFI
= .906 vs. .903, PNFI = .838 vs. .846, and RMR = .026 vs. .027, respectively. Meanwhile,
Model 3 provided a slightly better fit to the data in light of the goodness of fit indices for the
second sample: GFI = .919 vs. .913, AGFI = .908 vs. .902, NFI = .836 vs. .823, PNFI = .773
vs. .772, and RMR = .029 vs. .030, respectively.
Psychometric characteristics of the parental reports of anxiety symptoms
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A parental report of children’s anxiety symptoms
Table 4 shows the mean value and standard deviations by age and gender for mothers’
reports for 568 children. A MANOVA revealed no significant effects for gender or age x gender
for either the total scale score or any of the factor scores. However, a significant age effect for
obsessive-compulsive disorder was found, F (1, 562) = 37.52, p < .001; multiple comparisons
found no significant differences in terms of each age group.
Intercorrelations of the SCAS-P subscales ranged from weak to moderate, r = .29 to .54
(Table 5). The highest correlations were found among separation anxiety disorder, social phobia,
and generalized anxiety disorders, as well among generalized anxiety disorders and panic attack
and agoraphobia. In terms of correlations with the total scale score, the correlation coefficients
ranged from .80 to .65.
Following previous studies (Ishikawa et al., 2009; Spence et al., 2003), an estimate of the
common anxiety symptoms was indicated by the percentage of mothers that rated each item as
either 3 “often” or 4 “always” (Table 6). The most prevalent symptoms related to physical
injury fears (dark, insects/spiders, and dogs), separation anxiety disorders related to sleeping
alone and being on his/her own at home, and social phobia related to making a fool of oneself in
front of people and poor performance at school. The least frequently reported items by mothers
corresponded to panic attack and agoraphobia.
Reliability and validity of the SCAS-P
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A parental report of children’s anxiety symptoms
The internal consistency was computed for the SCAS-P total scale score as well as each
of the subscales. Cronbach’s alpha for the SCAS-P total score was .88. The internal consistency
of the each subscale was moderate: .65 for separation anxiety disorder, .65 for social phobia, .58
for generalized anxiety disorder, .75 for panic attack and agoraphobia, .66 for
obsessive-compulsive disorder, and .61 for f physical injury fears. In order to examine
convergent validity of the SCAS-P, scores were compared with those obtained from the
anxiety/depression subscale of the CBCL. The correlation between the SCAS-P total score and
the CBCL anxiety/depression score was 0.51 (p < .001). Each subscale also correlated
significantly with the CBCL anxiety/depression score: r = .38 for separation anxiety disorder, r
= .44 for social phobia, r = .48 for generalized anxiety disorder, r = .33 for panic attack and
agoraphobia, r = .38 for obsessive-compulsive disorder, and r = .27 for physical injury fears (all
ps < .001).
Age and gender effects on the SCAS
Table 7 shows the mean values and standard deviations by gender and age of the child for
the 677 children who completed the SCAS. A MANOVA was performed to examine age and
gender effects on the SCAS total scores and subscales. The total score and subscales of the
SCAS revealed significant gender and age differences. A gender x age effect was only found for
generalized anxiety disorders, F (2, 671) = 3.72, p < .05. Post hoc analyses revealed that girls
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A parental report of children’s anxiety symptoms
had more anxiety symptoms but only among 6th graders (p < .001). In terms of age, there were
no significant differences among girls, while 4th grade boys showed the highest anxiety
symptoms (p < .05).
Girls reported higher anxiety scores than boys for the full scale, F (1, 671) = 37.52, p
< .001, separation anxiety disorder, F (1, 671) = 27.70, p < .001, social phobia, F (1, 671) =
59.03, p < .001, generalized anxiety disorder, F (1, 671) = 12.10, p < .001, panic attack and
agoraphobia, F (1, 671) = 11.18, p < .001, obsessive-compulsive disorder, F (1, 671) = 13.34, p
< .001, and physical injury fears, F (1, 671) =39.49, p < .001. Moreover, there were significant
age differences for the total scale score, F (2, 671) = 13.10, p < .001, separation anxiety disorder,
F (2, 671) = 26.21, p < .001, social phobia, F (2, 671) = 7.06, p < .001, generalized anxiety
disorder, F (2, 671) = 4.83, p < .01, panic attack and agoraphobia, F (2, 671) = 6.33, p < .01,
obsessive-compulsive disorder, F (2, 671) = 9.48, p < .001, and physical injury fears, F (2, 671)
=5.22, p < .01. Multiple comparisons revealed that children in 4th grade had higher anxiety
symptoms than 5th and 6th grade children for the total scale score, separation anxiety disorder,
generalized anxiety disorder, and obsessive-compulsive disorder. For social phobia and panic
attack and agoraphobia, 6th graders had higher scores than 4th graders. In addition, 6th graders
had lower scores on the physical injury fears.
Relationship between parental and child self-reports
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A parental report of children’s anxiety symptoms
In terms of the paired data from 568 child-parent dyads, correlation analysis revealed that
most correlation coefficients between parental and child self-reports were significant but
relatively low (Table 8). Even among the subscales, which were evaluated as the same
conceptual, anxiety subtypes, the relationship between self- and parental reports were very weak
in the current sample. There was no significant correlation within the panic attack and
agoraphobia subscale; remaining coefficients within the same subscales were lower than .20.
We also directly compared the SCAS-P scores with the SCAS. As shown in Table 9, mothers’
scores were lower than child self-reported scores for the full scale score, t(567) = 14.22, p
< .001, separation anxiety disorder, t(567) = 8.32, p < .001, social phobia, t(567) = 11.92, p
< .001, generalized anxiety disorder, t(567) = 7.12, p < .001, panic attack and agoraphobia,
t(567) = 14.99, p < .001, obsessive-compulsive disorder, t(567) = 20.33, p < .001, and physical
injury fears, t(567) =3.76, p < .001.
Discussion
This study developed the Japanese version of the SCAS-P, examined its reliability and
validity, and investigated the relationship between child and parental reports of anxiety
symptoms among Japanese children. Confirmatory factor analysis based on mothers’ ratings
revealed that the parent scale could be satisfactorily explained by a 6-factor structure
corresponding to current diagnostic criteria. Thus, our results suggest that the parental measure
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A parental report of children’s anxiety symptoms
was partly consistent with the child version of the SCAS (Ishikawa et al., 2009). However,
compared with a correlated 6-factor model, goodness of fit indices of a higher order factor
model were the same, or at a slightly lower level, despite the model being supported by previous
studies on child self-report measures in Western and Japanese samples. The original study on
the SCAS-P also suggested that a model including a higher factor could not be satisfactorily
analyzed because most of the variance in the generalized anxiety disorder factor was explained
by an overarching general anxiety factor (Nauta et al., 2004). Whereas a higher order factor
model hypothesized that intercorrelations within the SCAS-P would be relatively steady, our
correlation analysis indicated moderate to weak coefficients among the subscales. In particular,
moderate correlations were found among separation anxiety disorder, social phobia, and
generalized anxiety disorder, but correlations were relatively weak between
obsessive-compulsive disorder and physical injury fears/panic attack and agoraphobia besides
panic attack and agoraphobia and separation anxiety disorder/social phobia. Therefore, in light
of the intercorrelations among the subscales, a correlated 6-factor model might have some
advantages relative to a higher order factor structure. Conversely, cross validation did not
provide clear differences among goodness of fit indices between Model 3 and Model 4 from one,
randomly selected sample. Thus, further research is necessary to examine a higher-order factor
model dealing with parental reports of childhood anxiety disorders.
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A parental report of children’s anxiety symptoms
Although the internal consistency of the full scale was satisfactory, the reliability of each
subscale was moderate. However, these results were similar to the original study using a
non-clinical sample (ranging .58 from .74). In terms of physical injury fears, the factor was
constructed based on various types of fear objects/specific fears. For this reason, previous
studies assessing the SCAS also indicate moderate levels of internal consistency physical injury
fears (e.g., Essau et al., 2002; Muris et al., 2000). The SCAS-P showed good convergent
validity for the Japanese sample. As predicted, the correlation between the full-scale scores and
subscale scores of the SCAS-P and the anxiety/depression subscale of the CBCL were
significant and moderate. However, the present study did not examine divergent and
discriminant validity of the SCAS-P. Future studies should examine correlations with a scale
examining externalizing disorders and utilize data from a clinical sample of children with
anxiety disorders.
Psychometric characteristics of the child reports of anxiety symptoms were consistent
with previous studies in Japan (Ishikawa et al., 2009) and Western countries (Spence, 1998;
Spence et al., 2003). The current study confirmed that girls reported more anxiety symptoms
than boys, and adolescents presented with fewer anxiety symptoms than younger children.
Conversely, the current study indicated no age and gender differences within the SCAS-P. The
original study (Nauta et al., 2004) also showed no gender differences but did find that younger
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A parental report of children’s anxiety symptoms
children showed significantly higher scores for separation anxiety disorder, generalized anxiety
disorder, and physical injury fears. Older age was associated with higher scores for panic attack
and agoraphobia. These results might be related with the age range within each study. For the
current study, we included children between the ages of 9 and 12, but the original study covered
an age range between 6 and 18. With regard to the prevalence of each item within the SCAS-P,
the most common anxiety symptoms dealt with specific fears of the dark and insects/spiders.
These items were also ranked highly among children reporting anxiety symptoms in the original
study. A previous cross-cultural study also reported that the fear of spiders, as well as other
fear-evoking animals, was the most frequent elicitor of anxiety among Japanese children as
compared to children in other countries (Davey et al., 1998). However, item analysis of the
SCAS indicated that an item for “checking” as related to obsessive-compulsive disorders was
the most frequently endorsed anxiety symptom by Japanese children and adolescents. The
corresponding item in the SCAS-P was ranked as the 10th most frequent set of symptoms.
Nauta and colleagues (2004) suggested that the items that represented internal processes were
difficult to observe than external behavioral symptoms by parental reports. However, items
related to “worrying about things” were ranked as highly common symptoms in both child and
parental reports. Thus, it is likely that Japanese parents did not frequently report symptoms
related to “checking.”
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A parental report of children’s anxiety symptoms
The current study indicated that scores on the SCAS-P were significantly lower than those
of the SCAS for both the total and subscale scores. Although a previous study (Ishikawa et al.,
2009), as well as our current study, indicated that the SCAS scores among Japanese children
were similar to those of Western children, the average SCAS-P score among Japanese children
(boys: mean age = 11.20, SD = 9.48, girls: mean age = 11.34, SD = 9.58, total: mean age =
11.27, SD = 9.53) could be lower compared to the original sample (boys: mean age = 16.0, SD =
11.6, girls: mean age = 15.9, SD = 9.0, for 6–11-year-olds). In terms of item analysis, Ishikawa
and colleagues mentioned the possibility that students who “check” themselves might be
regarded as “well-behaved” in the Japanese instructional system (Ishikawa et al., 2009). Thus,
we might presume that Japanese parents tend not to see their child’s anxiety symptoms related
to “checking” as serious does the child.
The most striking result of the current study was the relationship between child and
parental reports. The correlation coefficients for this relationship were very low or
non-significant. In the original sample, with a non-clinical child sample, at least weak to
moderate correlations were found between subscales from the SCAS and SCAS-P (Nauta et al.,
2004). Coefficients in the original study ranged from .60 to .27 among corresponding subscales;
correlations were lower than .20 in the current study. Such low positive correlations between
children’s self- and mothers’ reports suggests that when a child reports anxiety symptoms, the
22
A parental report of children’s anxiety symptoms
mother also recognizes her child has some anxiety symptoms; however, the mother might
sometimes overlooks her child’s symptoms, or her recognition is not at the same level as her
child’s. Future research should address the potential factors contributing to the inconsistency in
child and parental reports of anxiety symptoms within Japanese samples.
There were some additional limitations to our study. First, we failed to include data from
fathers into our entire analysis. Second, questionnaires focusing on adult psychopathology were
not included in this study. These variables might influence parents’ reports of their own child’s
psychopathology. Third, we did not include measures of other internalizing disorders, such as
depression (or other externalizing disorders) for children. Given this third limitation, it was
impossible for us to examine divergent validity of the SCAS-P. Fourth, the study did not include
any behavioral observations. We observed very low correlations between children’s self-reports
and mothers’ reports of anxiety symptoms. A third, objective variable could be useful for
examining the accuracy of parental reports as an indicator of children’s’ anxiety symptoms
(Spence et al., 2001). Fifth, we failed to assess younger children and older adolescents, as well a
child clinical sample. However, previous research on the SCAS in Japan replicated the original
factor structure by using not only a sample of children but also data collected from adolescents
(Ishikawa et al., 2009). Furthermore, an evaluation of discriminant validity by comparing
children with and without anxiety disorders is important for future research.
23
A parental report of children’s anxiety symptoms
In conclusion, the Japanese version of the SCAS-P shows adequate reliability and validity
as a parental instrument for assessing anxiety symptoms among children. This is especially the
case when the SCAS-P is used in conjunction with the SCAS. The factor structure of the
Japanese version of the SCAS-P was consistent with current diagnostic criteria. Although the
most frequently endorsed items within the SCAS-P were similar to those of the SCAS, some
items (which could be influenced by cultural norms) were not endorsed to the same extent by
parents. In Japan, the consistency between child and parental reports was lower than of the
original SCAS-P validation study (Nauta et al., 2004). This result could be implicated the low
level of concern or insufficient knowledge of childhood anxiety symptoms by Japanese parents.
If it is true, enlightenment of anxiety disorders in children and adolescents might be an urgent
task for Japanese clinical child psychology field.
24
A parental report of children’s anxiety symptoms
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28
A parental report of children’s anxiety symptoms
Table 1 Descriptive statistics of each item in the SCAS-P
SCAS-P items
Means
Standard
Skewness
Kurtosis
Deviations
(1) My child worries about things
0.98
0.73
0.54
0.34
(2) My child is scared of the dark
1.10
1.03
0.56
-0.83
(3) When my child has a problem, (s)he
0.39
0.70
1.78
2.47
(4) My child complains of feeling afraid
0.40
0.72
1.83
2.84
(5) My child would feel afraid of being on
0.47
0.80
1.74
2.29
0.11
0.36
3.66
15.41
0.26
0.61
2.75
7.95
0.39
0.67
1.77
2.84
0.49
0.76
1.55
1.77
complains of having a funny feeling in his/her
stomach
his/her own at home
(6) My child is scared when (s)he has to take a
test
(7) My child is afraid when (s)he has to use
public toilets
(8) My child worries about being away from
us/me
(9) My child feels afraid that (s)he will make a
29
A parental report of children’s anxiety symptoms
fool of him/herself in front of people
(10) My child worries that he/she will do
0.45
0.73
1.60
2.01
0.40
0.71
1.86
3.03
0.05
0.25
5.95
37.74
0.49
0.79
1.74
2.51
0.79
1.06
1.08
-0.22
0.08
0.32
4.27
18.91
(16) My child is scared of dogs
0.58
0.91
1.52
1.29
(17) My child can’t seem to get bad or silly
0.24
0.51
2.24
5.02
badly at school
(11) My child worries that something awful
will happen to someone in our family
(12) My child complains of suddenly feeling
as if (s)he can’t breathe when there is no
reason for this
(13) My child has to keep checking that(s)he
has done things right (like the switch is off, or
the door is locked)
(14) My child is scared if (s)he has to sleep on
his/her own
(15) My child has trouble going to school in
the mornings because (s)he feels nervous or
afraid
30
A parental report of children’s anxiety symptoms
thoughts out of his/her head
(18) When my child has a problem,
0.13
0.42
4.02
18.94
0.02
0.18
8.78
82.54
0.21
0.51
2.67
7.92
0.27
0.61
2.51
6.34
0.03
0.21
7.65
62.16
0.39
0.74
2.01
3.55
0.04
0.23
8.01
73.92
0.04
0.22
6.67
47.76
s(he)complains of his/her heart beating really
fast
(19) My child suddenly starts to tremble or
shake when there is no reason for this
(20) My child worries that something bad will
happen to him/her
(21) My child is scared of going to the doctor
or dentist
(22) When my child has a problem, (s)he feels
shaky
(23) My child is scared of heights (e.g. being
at the top of a cliff)
(24) My child has to think special thoughts
(like numbers or words) to stop bad things
from happening
(25) My child feels scared if (s)he has to travel
31
A parental report of children’s anxiety symptoms
in the car, or on a bus or train
(26) My child worries what other people think
0.43
0.70
1.61
2.04
0.05
0.25
5.80
35.91
0.03
0.21
9.60
106.52
(29) My child is scared of insects or spiders
0.88
1.06
0.90
-0.50
(30) My child complains of suddenly
0.06
0.26
4.42
20.70
0.31
0.61
1.98
3.44
0.05
0.27
7.01
58.59
0.04
0.23
5.70
35.30
of him/her
(27) My child is afraid of being in crowded
places (like shopping centres, the movies,
buses, busy playgrounds)
(28) All of a sudden my child feels really
scared for no reason at all
becoming dizzy or faint when there is no
reason for this
(31) My child feels afraid when (s)he has to
talk in front of the class
(32) My child complains of his/her heart
suddenly starting to beat too quickly for no
reason
(33) My child worries that (s)he will suddenly
32
A parental report of children’s anxiety symptoms
get a scared feeling when there is nothing to
be afraid of
(34) My child is afraid of being in small
0.19
0.51
3.11
10.46
0.09
0.39
5.06
28.82
0.10
0.34
3.80
14.81
0.17
0.46
2.87
8.28
0.07
0.31
5.14
30.01
closed places, like tunnels or small rooms
(35) My child has to do some things over and
over again (like washing his/her hands,
cleaning or putting things in a certain order)
(36) My child gets bothered by bad or silly
thoughts or pictures in his/her head
(37) My child has to do certain things in just
the right way to stop bad things from
happening
(38) My child would feel scared if (s)he had to
stay away from home overnight
33
A parental report of children’s anxiety symptoms
Table 2 Goodness fit indices for the 5 models
Model
GFI
AGFI
NFI
PNFI
RMR
Model 1. 1 factor
.940
.934
.883
.835
.026
Model 2. 6 uncorrelated factors
.616
.572
.249
.235
.066
Model 3. 6 correlated factors
.950
.942
.901
.833
.024
Model 4. 6 correlated factors and one higher
.946
.939
.895
.839
.025
.940
.932
.882
.829
.026
order factor
Model 5. 5 correlated factors and generalized
anxiety as one higher order factor
Note: AGFI= Adjusted Goodness Fit Index, GFI= Goodness Fit Index, NFI = Normed Fit Index,
PNFI = Parsimonious Normed Fit Index, RMR = Root Mean Square Residual
34
A parental report of children’s anxiety symptoms
Table 3 Confirmatory factor analysis of the SCAS-P
Original
SCAS-P items
scale
Separation
(5) My child would feel afraid of being on
Anxiety
his/her own at home
Disorder
(8) My child worries about being away from
F
F
F
F
F
F
1
2
3
4
5
6
.67
.62
us/me
(11) My child worries that something awful will
.40
happen to someone in our family
(14) My child is scared if (s)he has to sleep on
.64
his/her own
(15) My child has trouble going to school in the
.40
mornings because (s)he feels nervous or afraid
(38) My child would feel scared if (s)he had to
.37
stay away from home overnight
Social
(6) My child is scared when (s)he has to take a
Phobia
test
(7) My child is afraid when (s)he has to use
35
.43
.53
A parental report of children’s anxiety symptoms
public toilets
(9) My child feels afraid that (s)he will make a
.47
fool of him/herself in front of people
(10) My child worries that he/she will do badly
.44
at school
(26) My child worries what other people think
.54
of him/her
(31) My child feels afraid when (s)he has to talk
.54
in front of the class
Generalize
(1) My child worries about things
.37
d anxiety
(3) When my child has a problem, (s)he
.37
disorder
complains of having a funny feeling in his/her
stomach
(4) My child complains of feeling afraid
.65
(18) When my child has a problem,
.39
s(he)complains of his/her heart beating really
fast
(20) My child worries that something bad will
36
.53
A parental report of children’s anxiety symptoms
happen to him/her
(22) When my child has a problem, (s)he feels
.26
shaky
Panic
(12) My child complains of suddenly feeling as
attack and
if (s)he can’t breathe when there is no reason for
agoraphobi
this
a
(19) My child suddenly starts to tremble or
.38
.45
shake when there is no reason for this
(25) My child feels scared if (s)he has to travel
.35
in the car, or on a bus or train
(27) My child is afraid of being in crowded
.42
places (like shopping centres, the movies, buses,
busy playgrounds)
(28) All of a sudden my child feels really scared
.42
for no reason at all
(30) My child complains of suddenly becoming
.36
dizzy or faint when there is no reason for this
(32) My child complains of his/her heart
37
.46
A parental report of children’s anxiety symptoms
suddenly starting to beat too quickly for no
reason
(33) My child worries that (s)he will suddenly
.45
get a scared feeling when there is nothing to be
afraid of
(34) My child is afraid of being in small closed
.60
places, like tunnels or small rooms
Obsessive-
(13) My child has to keep checking that(s)he
compulsive
has done things right (like the switch is off, or
disorder
the door is locked)
(17) My child can’t seem to get bad or silly
.50
.64
thoughts out of his/her head
(24) My child has to think special thoughts (like
.35
numbers or words) to stop bad things from
happening
(35) My child has to do some things over and
over again (like washing his/her hands, cleaning
or putting things in a certain order)
38
.47
A parental report of children’s anxiety symptoms
(36) My child gets bothered by bad or silly
.53
thoughts or pictures in his/her head
(37) My child has to do certain things in just the
.52
right way to stop bad things from happening
Physical
(2) My child is scared of the dark
.67
injury fears
(16) My child is scared of dogs
.36
(21) My child is scared of going to the doctor or
.46
dentist
(23) My child is scared of heights (e.g. Being at
.44
the top of a cliff)
(29) My child is scared of insects or spiders
39
.46
A parental report of children’s anxiety symptoms
Table 4 Means and standard deviations (in parentheses) of the SCAS-P
4th grade
5th grade
6th grade
Boys
Girls
Boys
Girls
Boys
Girls
(n = 82)
(n = 79)
(n = 99)
(n = 98)
(n = 99)
(n = 111)
2.02
1.94
2.34
2.18
2.30
2.32
(2.50)
(2.29)
(2.50)
(2.40)
(2.80)
(2.61)
Social
1.52
2.00
2.22
1.95
2.03
2.43
Phobia
(1.89)
(2.46)
(2.21)
(2.24)
(2.41)
(2.56)
Generalized
1.94
2.15
2.34
1.87
2.07
2.43
(1.75)
(1.96)
(1.85)
(1.59)
(2.04)
(2.40)
0.49
0.57
0.53
0.42
0.56
0.58
(1.08)
(2.11)
(0.95)
(0.91)
(2.09)
(1.18)
0.79
0.87
1.30
1.12
1.52
1.00
(1.28)
(1.69)
(1.62)
(1.93)
(2.30)
(1.48)
Separation
anxiety
disorder
anxiety
disorder
Panic attack
and
agoraphobia
Obsessivecompulsive
disorder
40
A parental report of children’s anxiety symptoms
Physical
3.18
3.30
3.53
3.12
2.70
3.52
injury fears
(2.98)
(3.06)
(2.73)
(2.55)
(2.53)
(2.81)
Total
9.95
10.84
12.26
10.66
11.17
12.29
(8.46)
(10.86)
(8.71)
(8.14)
(10.89)
(9.80)
41
A parental report of children’s anxiety symptoms
Table 5 Intercorrelations of the SCAS-P subscales
n = 568
Separation Social
anxiety
Generalized Panic attack
Phobia anxiety
disorder
disorder
and
Obsessive-compulsive Physical Total
disorder
agoraphobia
injury
fears
SAD
SoP
.54**
GAD
.54**
.53**
Panic/Ag .37**
.38**
.54**
OCD
.45**
.48**
.45**
.49**
PhInj
.50**
.46**
.48**
.34**
.29**
Total
.80**
.78**
.78**
.65**
.67**
** p < .01
42
.74**
A parental report of children’s anxiety symptoms
Table 6 Most common anxiety symptoms for Japanese children
Rated as “often”
SCAS-P items
or “always” (%)
(2) My child is scared of the dark
30.63
(29) My child is scared of insects or spiders
24.47
(14) My child is scared if (s)he has to sleep on his/her own
22.01
(1) My child worries about things
19.19
(16) My child is scared of dogs
14.26
(5) My child would feel afraid of being on his/her own at home
11.09
(9) My child feels afraid that (s)he will make a fool of him/herself
10.92
in front of people
(10) My child worries that he/she will do badly at school
9.68
(13) My child has to keep checking that(s)he has done things right
9.68
(like the switch is off, or the door is locked)
(3) When my child has a problem, (s)he complains of having a
9.51
funny feeling in his/her stomach
(4) My child complains of feeling afraid
8.98
(26) My child worries what other people think of him/her
8.98
(23) My child is scared of heights (e.g. Being at the top of a cliff)
8.63
(11) My child worries that something awful will happen to
8.45
someone in our family
(8) My child worries about being away from us/me
7.39
(31) My child feels afraid when (s)he has to talk in front of the
6.34
class
(21) My child is scared of going to the doctor or dentist
5.46
(7) My child is afraid when (s)he has to use public toilets
4.58
(34) My child is afraid of being in small closed places, like tunnels
3.52
or small rooms
(17) My child can’t seem to get bad or silly thoughts out of his/her
3.35
head
(20) My child worries that something bad will happen to him/her
2.99
(37) My child has to do certain things in just the right way to stop
2.99
bad things from happening
(18) When my child has a problem, s(he)complains of his/her heart
beating really fast
43
1.76
A parental report of children’s anxiety symptoms
(35) My child has to do some things over and over again (like
1.76
washing his/her hands, cleaning or putting things in a certain order)
(15) My child has trouble going to school in the mornings because
1.41
(s)he feels nervous or afraid
(36) My child gets bothered by bad or silly thoughts or pictures in
1.41
his/her head
(6) My child is scared when (s)he has to take a test
1.23
(38) My child would feel scared if (s)he had to stay away from
1.23
home overnight
(12) My child complains of suddenly feeling as if (s)he can’t
0.88
breathe when there is no reason for this
(27) My child is afraid of being in crowded places (like shopping
0.88
centres, the movies, buses, busy playgrounds)
(22) When my child has a problem, (s)he feels shaky
0.70
(24) My child has to think special thoughts(like numbers or words)
0.70
to stop bad things from happening
(25) My child feels scared if (s)he has to travel in the car, or on a
0.70
bus or train
(32) My child complains of his/her heart suddenly starting to beat
0.70
too quickly for no reason
(19) My child suddenly starts to tremble or shake when there is no
0.53
reason for this
(28) All of a sudden my child feels really scared for no reason at all
0.53
(30) My child complains of suddenly becoming dizzy or faint when
0.53
there is no reason for this
(33) My child worries that (s)he will suddenly get a scared feeling
when there is nothing to be afraid of
44
0.53
A parental report of children’s anxiety symptoms
Table 7 Means and standard deviations (in parentheses) of the SCAS
4th grade
5th grade
6th grade
Boys
Girls
Boys
Girls
Boys
Girls
(n = 105)
(n = 95)
(n = 118)
(n = 112)
(n = 118)
(n = 129)
4.35
5.31
2.96
4.46
1.77
3.34
(3.87)
(3.83)
(2.98)
(3.76)
(2.19)
(3.10)
Social
3.81
5.20
3.07
4.95
2.25
4.54
Phobia
(3.29)
(3.33)
(2.91)
(3.78)
(2.60)
(2.83)
Generalized
3.80
4.01
2.74
3.35
2.15
3.96
(3.28)
(3.56)
(3.00)
(3.43)
(2.78)
(3.51)
3.40
4.36
2.70
3.63
2.06
3.12
(3.83)
(3.94)
(3.58)
(4.25)
(3.17)
(3.98)
4.63
5.56
3.96
4.22
2.95
4.58
(3.15)
(3.87)
(3.27)
(3.33)
(2.86)
(3.30)
Separation
anxiety
disorder
anxiety
disorder
Panic attack
and
agoraphobia
Obsessivecompulsive
disorder
45
A parental report of children’s anxiety symptoms
Physical
3.50
4.77
3.45
4.67
2.47
4.22
injury fears
(2.89)
(3.17)
(2.87)
(2.86)
(2.79)
(2.93)
Total
23.50
29.20
18.87
25.28
13.64
23.78
(16.29)
(17.38
(14.87)
(17.80)
(12.73)
(14.99)
46
A parental report of children’s anxiety symptoms
Table 8 Correlations between the SCAS-P and the SCAS
SCAS/SCAS-P Separation Social
n = 568
anxiety
Generalized Panic attack
Phobia anxiety
disorder
and
disorder
agoraphobia
Obsessive-compulsive Physical Total
disorder
injury
fears
SAD
.16**
.16**
.12**
.09*
.13**
.12**
.16**
SoP
.05
.19**
.10*
.07
.13**
.10*
.13**
GAD
.10*
.15**
.13**
.10*
.17**
.14**
.16**
Panic/Ag
.04
.12**
.08
.05
.10*
.08
.09*
OCD
.09**
.20**
.11*
.07
.15**
.07
.14**
PhInj
.04
.11**
.08
.04
.05
.17**
.10*
Total
.11**
.21**
.14**
.09*
.16**
.16**
.17**
* p < .05, ** p < .01
47
A parental report of children’s anxiety symptoms
Table 9 Means and standard deviations of the SCAS and the SCAS-P
SCAS
SCAS-P
(n = 568)
(n = 568)
Separation anxiety disorder
3.59
(3.52)
2.20
(2.52)
Social Phobia
3.88
(3.03)
2.51
(2.32)
Generalized anxiety disorder
3.24
(3.35)
2.15
(1.97)
Panic attack and agoraphobia
3.10
(3.91)
0.52
(1.45)
Obsessive-compulsive disorder
4.20
(3.41)
1.12
(1.77)
Physical injury fears
3.82
(3.00)
3.23
(2.77)
Total
21.82
(16.66)
11.27
(9.53)
48
A parental report of children’s anxiety symptoms
Footnote
1
However, we also conducted multi-group confirmatory factor analysis by using fathers’ data in
order to examine consistency of two groups’ (mothers and fathers) factor structures.
2
In terms of Model 3, multi-group analysis was also conducted by using the data from mothers’
(n = 568) and fathers’ reports (n = 59). In this analysis, two models were compared: 1) a
configural invariance model that included no constrained variables and 2) a metric invariance
model that represented coefficients from each factor for observed variables that were assumed
to be equivalent between the two populations. Goodness of fit indices indicated that the
configural invariance model was, overall, a better fit to the data than the metric invariance
model: GFI = .944 vs. .936, AGFI = .936 vs. .928, NFI = .891 vs. .875, and RMR = .30 vs. .37,
PNFI = .824 vs. .829.
49