The revised version of the Screen for Child AnxietyRelated Emotional Disorders (SCARED-R): Factor

structure in normal children

Peter Muris a, *, Harald Merckelbacha, Henk Schmidt a, Birgit Mayerb

aDepartment of Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The NetherlandsbDepartment of Experimental Abnormal Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht,

The Netherlands

Received 18 December 1997

Abstract

The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R) is aself-report questionnaire that measures symptoms of DSM-IV linked anxiety disorders in children. Thepresent study examined the factor structure of the SCARED-R in a sample of 674 normal Dutch schoolchildren aged 8 to 13 years. Exploratory factor analysis (principal components with oblimin rotation)clearly pointed in the direction of a 1-factor solution, suggesting that when applied to samples of normalchildren, the SCARED-R is a unidimensional measure. Additional exploratory and con®rmatory factoranalyses carried out on parts of the SCARED-R provided some support for the presence of thefollowing factors: panic disorder, generalized anxiety disorder, separation anxiety disorder, schoolphobia, social phobia and three types of speci®c phobias. Implications of these ®ndings for the use ofthe SCARED-R are brie¯y discussed. # 1998 Elsevier Science Ltd. All rights reserved.

Keywords: Anxiety disorders; Screen for Child Anxiety Related Emotional Disorders; Self-report questionnaire; Nor-

mal children; Factor analysis

1. Introduction

Anxiety disorders are one of the most common psychiatric problems in children. Estimatesfor the presence of any anxiety disorder range between 5.7 and 17.7%, with half of themexceeding the 10% rate (Costello and Angold, 1995). The latest edition of the Diagnostic and

Personality and Individual Differences 26 (1999) 99±112

S0191-8869/98/$19.00 # 1998 Elsevier Science Ltd. All rights reserved.PII: S0191-8869(98)00130-5

PERGAMON

* Corresponding author. E-mail: p.muris@psychology.unimaas.nl

Statistical Manual of Mental Disorders (DSM-IV; APA, 1994) which is the most currentclassi®catory system in many countries (including The Netherlands), recognizes the followinganxiety disorders in children: generalized anxiety disorder, separation anxiety disorder, panicdisorder, speci®c phobia, social phobia, obsessive±compulsive disorder and posttraumatic oracute stress disorder. Epidemiological studies have revealed that generalized anxiety disorder,separation anxiety disorder and speci®c phobias are the most commonly diagnosed anxietydisorders, occurring in about 5% of the children. Social phobia and panic disorder are lessfrequent with prevalence rates generally below 2%, while obsessive±compulsive disorder andposttraumatic or acute stress disorders are even more rare. There is evidence to suggest thatsubclinical manifestations of anxiety disorders are also relatively prevalent among children. Forexample, Bell-Dolan et al. (1990) found that symptoms of generalized anxiety disorder,separation anxiety disorder, and speci®c phobias were present in 20±30% of a sample of never-psychiatrically ill children.Structured and semistructured interviews can be used to reliably assess anxiety disorders

symptomatology in children. However, these interviews are time-consuming and often requiretrained interviewers. Alternatively, self-report questionnaires can be employed to measureanxiety symptoms in children. Currently, the three most widely used scales for this purpose arethe Revised Children's Manifest Anxiety Scale (RCMAS; Reynolds and Richmond, 1978), theState-Trait Anxiety Inventory for Children (STAIC; Spielberger, 1973) and the Fear SurveySchedule for Children, Revised (FSSC-R; Ollendick, 1983). It should be noted that these scalesare global and unidimensional and not keyed to the separate anxiety disorders as listed in theDSM.Recently, several attempts have been made to develop multidimensional questionnaires for

assessing childhood anxiety symptoms. A ®rst example is the Multidimensional Anxiety Scalefor Children (MASC; March et al., 1997), a self-report measure comprising four empirically-derived domains of childhood anxiety: physical anxiety, harm avoidance, social anxiety andseparation anxiety. Another example is the Children's Anxiety Scale (CAS; Spence, 1997) thattaps symptoms of a number of DSM-de®ned anxiety disorders, namely panic disorder,separation anxiety disorder, social phobia, obsessive±compulsive disorder and generalizedanxiety disorder. In addition, the CAS contains a physical fears scale which represents theDSM-category of speci®c phobias. Interestingly, Spence (1997) showed in a factor-analyticstudy that anxiety symptoms as listed in the CAS cluster into subtypes of anxiety problemsthat are largely consistent with the classi®cation of anxiety disorders as proposed in the DSM.The Screen for Child Anxiety Related Emotional Disorders (SCARED; Birmaher et al.,

1997) is also a multidimensional questionnaire that purports to measure DSM-de®ned anxietysymptoms. Factor analysis performed on the SCARED scores of clinically referred childrenrevealed that the 38 items of the SCARED can be allocated to ®ve separate anxiety subscales.Four of these subscales represent anxiety disorders that correspond with DSM categories,namely panic disorder, generalized anxiety disorder, social phobia, and separation anxietydisorder. The ®fth subscale is school phobia which, according to Birmaher et al. (1997, p. 551)can best be considered as ``a common clinical entity that is seen both comorbidly andindependently from other anxiety disorders''. Muris (1997) revised the SCARED in three ways.To begin with, school phobia items were joined to the separation anxiety disorder subscale.This was done because the DSM (see especially the DSM-III-R; APA, 1987) views school

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112100

phobia as a symptom of separation anxiety disorder. Secondly, 15 new items were added in anattempt to index symptoms of speci®c phobia. The DSM-IV distinguishes three subtypes:animal phobia, situational±environmental phobia and blood-injection-injury phobia [seeFrederikson et al. (1996), Muris et al. (submitteda) who provided evidence for these threeseparate categories of speci®c phobias]. Because speci®c fears and phobias are highly prevalentamong children (Bernstein et al., 1996), items of all three subtypes were included in the revisedSCARED. Thirdly, although obsessive±compulsive disorder and traumatic stress disorder arerelatively rare, an extra 13 items were added so that it would also be possible to tap symptomsof these disorders with the revised SCARED. Thus, the ®nal 66-item revised version of theSCARED purports to measure the symptoms of the entire anxiety disorders spectrum that,according to the DSM-IV, may occur in children.Previous research of our group (Muris et al., in press, 1998) has provided evidence for the

concurrent validity of the SCARED-R. For example, SCARED-R scores were found to bepositively related to levels of anxiety as indexed by traditional childhood anxiety measures.More speci®cally, the SCARED-R total score correlated 0.86 with RCMAS, 0.62 with theFSSC-R and 0.73 with the trait version of the STAIC.The current study examined the factor structure of the SCARED-R in more detail. Normal

school children (N=674) aged between 8 and 13 years completed the questionnaire. The mainpurpose of the present study was to investigate whether factor analyses would reveal clusters ofitems that are related to DSM categories in a meaningful way.

2. Method

2.1. Sample

674 children (330 boys and 344 girls) of 8 primary schools in the Maastricht area, TheNetherlands, completed the SCARED-R in their classrooms. Ages of the children rangedbetween 8 and 13 years, with a mean age of 10.28 years (S.D.=1.22). To enhance therepresentativeness of the sample, schools were selected from urban (n=5) and rural (n=3)areas and from low (n=2), middle (n=5) and high (n=1) social class districts. More than95% of the children were white. Consent to participate was obtained from schools and parents.Approximately 90% of those invited to take part did so.

2.2. Questionnaire

The SCARED-R contains 66 items that can be allocated to 9 separate DSM-IV linkedsubscales: panic disorder, separation anxiety disorder (including school phobia), generalizedanxiety disorder, social phobia, speci®c phobias (3 types: animal phobia, situational±environmental phobia and blood-injection-injury phobia), obsessive±compulsive disorder andtraumatic stress disorder. The anxiety disorders, their essential DSM-IV (APA, 1994) featuresand the belonging SCARED-R items are shown in Table 1. Children are asked to rate howfrequently they have experienced each symptom using a 3-point scale (i.e. 0= almost never,

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112 101

Table

1SCARED-R

item

sbelongingto

theseparate

DSM-IV

de®ned

anxiety

disorders.Meanratingofeach

item

,item

-totalscale

anditem

-subscale

corre-

lationsare

shownin

therightcolumns

Anxiety

disorder

Key

featuresaccordingto

the

DSM-IV

(APA,1994)

SCARED-R

item

s

Mean

rating

(0±2)

Item

,totalscale

correlation

Item

,subscale

correlation$

Panic

disorder

Thepresence

ofrecurrent,

unexpectedpanic

attacks(A

PA,

1994,p.397);apanic

attack

isa

discreteperiodofintense

fearor

discomfort

thatisaccompaniedby

atleast

4somaticorcognitive

symptoms(e.g.palpitations,

sweating,trem

blingorshaking,

fearofgoingcrazy,fearofdying)

(APA,1994,p.394)

When

frightened,itishard

tobreathe(1)

0.32

0.42

0.46

When

frightened,Ifeel

likepassingout(9)

0.17

0.43

0.47

People

tellmethatIlooknervous(14)

0.12

0.23

0.24

When

frightened,Ifeel

likegoingcrazy

(18)

0.16

0.41

0.47

When

frightened,Ifeel

thatthingsare

notreal(27)

0.31

0.40

0.35

When

frightened,myheart

beats

fast

(32)

1.12

0.48

0.38

Ifeel

weakandshaky(35)

0.25

0.40

0.43

When

frightened,Isw

eatalot(40)

0.38

0.36

0.39

Iget

reallyfrightened

fornoreason(44)

0.24

0.47

0.49

When

frightened,Ifeel

likeIam

choking(48)

0.17

0.45

0.56

Iam

afraid

ofhavinganxiety

attacks(51)

0.23

0.50

0.50

When

frightened,Ifeel

likethrowingup(56)

0.22

0.44

0.45

When

frightened,Ifeel

dizzy

(60)

0.20

0.43

0.47

Separation

anxiety

disorder

(includingschool

phobia)

Excessiveanxiety

concerning

separationfrom

thehomeand

from

those

towhom

thepersonis

attached

(APA,1994,p.110);

childrenwiththisdisorder

maybe

reluctantorrefuse

toattendschool

Iget

scaredwhen

Isleepawayfrom

home(7)

0.22

0.36

0.39

Ifollow

myparents

wherever

they

go(13)

0.70

0.34

0.34

Iworryaboutsleepingalone(19)

0.28

0.42

0.40

Ihavenightm

aresaboutmyparents

(29)

0.19

0.39

0.34

Ihavenightm

aresaboutbadhappeningto

me(36)

0.53

0.57

0.42

Iam

afraid

tobealoneathome(45)

0.41

0.39

0.42

Idon'tlikebeingawayfrom

myfamily(50)

0.71

0.44

0.39

Iworrythatbadhappensto

myparents

(52)

0.82

0.57

0.51

Iget

headaches

orstomach

aches

when

Iam

atschool(3)

0.29

0.28

0.24

Idon'tlikegoingto

school(17)

0.65

0.16

0.25

Iworryaboutgoingto

school(30)

0.20

0.33

0.42

Iam

scaredto

goto

school(58)

0.12

0.42

0.42

Generalized

anxiety

disorder

Excessiveanxiety

andworryabout

anumber

ofevents

oractivities

(APA,1994,p.432)

Iworryaboutothersnotlikingme(8)

0.43

0.41

0.47

Iam

nervous(11)

0.88

0.41

0.36

Iworryaboutbeingasgoodasother

kids(21)

0.36

0.47

0.49

Iworryaboutthingsworkingoutforme(38)

0.38

0.55

0.57

Iam

aworrier(41)

0.49

0.52

0.53

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112102

Table

1(continued

)

Anxiety

disorder

Key

featuresaccordingto

the

DSM-IV

(APA,1994)

SCARED-R

item

s

Mean

rating

(0±2)

Item

,

totalscale

correlation

Item

,

subscale

correlation$

People

tellmeIworrytoomuch

(49)

0.24

0.41

0.49

Iworryaboutthefuture

0.45

0.43

0.48

Iworryabouthow

wellIdothings(57)

0.41

0.46

0.47

Iworryaboutthingsthathappened

inthepast

(59)

0.42

0.49

0.40

Socialphobia

Marked

andpersistentfearof

socialorperform

ance

situationsin

whichem

barrassmentmayoccur

(APA,1994,p.411)

Idon'tliketo

bewithpeople

Idon'tknow

(4)

0.85

0.34

0.41

Ifeel

nervouswithpeople

Idon'tknow

well(15)

0.60

0.42

0.55

I®ndithard

totalk

withpeople

Idon'tknow

(47)

0.65

0.45

0.50

Iam

shywithpeople

Idon'tknow

well(53)

0.76

0.42

0.48

Speci®cphobias

Marked

andpersistentfearofa

clearlydiscernable,circumscribed

object

orsituation;exposure

tothe

phobic

stim

ulusalm

ost

invariably

provokes

anim

mediate

anxiety

response

(APA,1994,p.405);

subtypes

includeanim

als,

situational,natural-environment

andblood-injection-injury

Iam

afraid

ofananim

althatisnotreallydangerous(22)

0.32

0.26

0.61

Iam

soscaredofaharm

less

anim

althatIdonotdare

totouch

it(37)

0.31

0.32

0.57

Iam

afraid

ofananim

althatmost

childrendonotfear

(65)

0.26

0.39

0.54

When

Iseeblood,Iget

dizzy

(5)

0.29

0.27

0.31

Iam

afraid

tovisitthedoctor(16)

0.28

0.34

0.42

Iam

afraid

tovisitthedentist

(20)

0.35

0.35

0.39

Iam

scaredwhen

Iget

aninjection(33)

0.56

0.40

0.50

Iam

afraid

toget

aseriousdisease

(34)

0.59

0.48

0.32

Ifeel

scaredwhen

Iwatchanoperation(42)

1.00

0.40

0.45

Idon'tlikebeingin

ahospital(66)

0.72

0.33

0.37

Iam

afraid

ofheights

(2)

0.63

0.36

0.36

Iget

scaredwhen

thereisthunder

intheair(23)

0.39

0.41

0.40

Ifeel

scaredwhen

Ihaveto

¯yin

anaeroplane(28)

0.39

0.28

0.34

Iget

scaredin

small,closedplaces(61)

0.58

0.56

0.43

Iam

afraid

ofthedark

(63)

0.48

0.45

0.46

(continued

onnextpage)

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112 103

Table

1(continued

)

Anxiety

disorder

Key

featuresaccordingto

the

DSM-IV

(APA,1994)

SCARED-R

item

s

Mean

rating

(0±2)

Item

,

totalscale

correlation

Item

,

subscale

correlation$

Obsessive±

compulsive

disorder

Recurrentobsessionsand/or

compulsionsthatare

severe

enoughto

betimeconsumingor

cause

marked

distressorsigni®cant

impairment;obsessionsare

persistentideasorthoughts

that

cause

marked

anxiety

ordistress;

compulsionsare

repetitive

behaviours

thegoalofwhichisto

preventorreduce

anxiety

and

distress(A

PA,1994,p.417±418)

Iwantthatthingsare

ina®xed

order

(6)

0.45

0.37

0.38

IthinkthatIwillbecontaminatedwithaseriousdisease

(10)

0.38

0.37

0.29

Ihavethoughts

thatfrightenme(12)

0.86

0.54

0.46

Idothingsmore

thantw

icein

order

tocheckwhether

I

did

itright(24)

0.66

0.35

0.35

Iwantthingsto

becleanandtidy(26)

0.69

0.23

0.25

Idothingsto

get

less

scaredofmythoughts

(31)

0.50

0.49

0.48

Idoubtwhether

Ireallydid

something(39)

0.44

0.47

0.44

Ifantasize

abouthurtingother

people

(54)

0.23

0.33

0.27

Ihavethoughts

thatIprefernotto

have(62)

0.70

0.57

0.47

Traumaticstress

disorder

Characteristicanxiety

symptoms

thatoccurafter

exposure

toan

extrem

etraumaticstress

or

involvingdirectpersonal

experience

ofaneventthat

involves

actualorthreatened

death

orseriousinjury

orwitnessingan

eventthatinvolves

death,injury

or

threatto

thephysicalintegrity

of

another

person(A

PA,1994,p.424)

IhavefrighteningdreamsaboutaveryaversiveeventI

once

experienced(25)

0.61

0.50

0.53

Itrynotto

thinkaboutaveryaversiveeventIonce

experienced(43)

0.72

0.53

0.62

Iget

scaredwhen

Ithinkback

toaveryaversiveeventI

once

experienced(46)

0.60

0.58

0.69

Ihaveunbidden

thoughts

aboutaveryaversiveeventI

once

experienced(64)

0.54

0.57

0.63

SCARED-R

=ScreenforChildAnxiety

RelatedEmotionalDisorders,

Revised.$F

orthecalculationofitem

-subscale

correlations,

anim

alphobia,

situational±environmentalphobia

andblood-injection-injury

phobia

wereconsidered

asseparate

subscales.

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112104

1= sometimes and 2= often). SCARED-R total score and subscale scores are derived bysumming relevant items.

2.3. Procedure

Children completed the SCARED-R in their classrooms. The instruction (``A number ofstatements which refer to children's fears and anxiety are given below. Read each statementand indicate how frequent you have that symptom: almost never, sometimes, or often. There areno right or wrong answers''.) was read aloud by a research assistant while children read along.Children were asked whether they had any questions about the instrument and told that theirresponses would remain con®dential. In the younger classes (ages 8 and 9), SCARED-R itemswere read aloud as children marked their responses. Older children completed the SCARED-Ron their own. A second research assistant or the teacher was always available to assist childrenwho had questions while completing the instrument and to ensure that children workedindependently.

2.4. Statistical analysis

The statistical package SPSS was used to carry out the exploratory factor analyses. For thecon®rmatory factor analyses, EQS, the structural equations modeling approach (Bentler, 1989),was employed. With this approach, it becomes possible to test plausible alternative models thatmay underlie a data set. EQS produces a wide range of goodness-of-®t indices. In the presentstudy, the following indices were used: (a) chi square divided by degrees of freedom (this valueshould be about 2.00 or lower; the lower this value, the better the ®t), (b) the average absolutestandardized residuals (AASR; this value should be lower than 0.05; the lower this value, thebetter the ®t) and (c) the comparative ®t index (CFI; this value should be 0.80 or higher for areasonable ®t; the higher this value, the better the ®t).

3. Results

3.1. General results

Table 1 also shows the mean ratings for the 66 SCARED-R items. As can be seen, the 10most frequently reported symptoms were ``When frightened, my heart beats fast'', ``I feelscared when I watch an operation'', ``I am nervous'', ``I have thoughts that frighten me'', ``Idon't like to be with people I don't know'', ``I worry that bad happens to my parents'', ``I amshy with people I don't know'', ``I try not to think about a very aversive event I onceexperienced'', ``I don't like being in a hospital'' and ``I don't like being away from my family''.The 10 most rarely experienced symptoms were ``I am scared to go to school'', ``People tell methat I look nervous'', ``When frightened, I feel like going crazy'', ``When frightened, I feel likeI am choking'', ``When frightened I feel like passing out'', ``I have nightmares about myparents'', ``I worry about going to school'', ``When frightened, I feel dizzy'', ``When frightened,I feel like throwing up'' and ``I get scared when I sleep away from home''.

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112 105

General statistics of the SCARED-R are presented in Table 2. Note that the SCARED-R isa reliable instrument in terms of internal consistency. That is, Cronbach's alphas were 0.94 forthe total SCARED-R and ranged from 0.64 (situational±environmental phobia) to 0.80 (panicdisorder and traumatic stress disorder) for the separate SCARED-R subscales. In line withthese satisfactory values, most item-subscale correlations (more than 90%) were well above0.30 (see Table 1).Furthermore, signi®cant sex di�erences were found on SCARED-R total score [t(672)=7.1,

P<0.001], panic disorder [t(648.6, adjusted df )=5.5, P<0.001], generalized anxiety disorder[t(672)=4.3, P<0.001], social phobia [t(672)=4.8, P<0.001], separation anxiety disorder[t(659.6, adjusted df)=5.9, P<0.001], obsessive±compulsive disorder [t(672)=3.1, P<0.005],traumatic stress disorder [t(667.5, adjusted df )=5.5, P<0.001], animal phobia [t(650.9,adjusted df)=4.9, P<0.001], blood-injection-injury phobia [t(672)=6.3, P<0.001] andsituational±environmental phobia [t(662.4, adjusted df )=6.7, P<0.001]: girls more frequentlyreported anxiety disorder symptoms than boys.Finally, small but signi®cant, negative correlations were found between age, on the one

hand, and most of the SCARED-R scales, on the other hand. This result suggests that anxietydisorders symptoms declined with age.

3.2. Factor structure of the 66-item SCARED-R

A principal-components factor analysis with Oblimin rotation (i.e. a rotation which acceptsthat factors are intercorrelated) was performed on the 66-item SCARED-R. This analysisrevealed 17 factors with eigenvalues greater than 1.00. The scree plot, however, clearlysuggested a 1-factor solution accounting for 20.5% of the variance (eigenvalues of the ®rst 17factors were 13.50, 2.51, 2.23, 2.00, 1.76, 1.68, 1.63, 1.42, 1.38, 1.33, 1.25, 1.17, 1.14, 1.12, 1.09,1.04 and 1.02). The item-total scale correlations of the 66 SCARED-R items are presented inthe right columns of Table 1. As can be seen, 1 item (``I don't like going to school'') correlated

Table 2General statistics (mean scores, Cronbach's alphas, sex di�erences, and relationship with age) of the SCARED-R

Total group(N=674)

Boys(n=330)

Girls(n=344) a r with age

Total score 30.43 (17.88) 25.63 (16.34)a 35.03 (18.10)b 0.94 ÿ0.13$Panic disorder 3.89 (3.60) 3.13 (3.09)a 4.63 (3.90)b 0.80 ÿ0.06Generalized anxiety disorder 4.05 (3.29) 3.51 (3.06)a 4.58 (3.42)b 0.79 0.01

Social phobia 2.86 (2.00) 2.48 (2.00)a 3.22 (1.94)b 0.70 ÿ0.12$Separation anxiety disorder 5.12 (3.48) 4.34 (3.07)a 5.86 (3.68)b 0.71 ÿ0.16$Obsessive±compulsive disorder 4.89 (3.19) 4.51 (3.20)a 5.26 (3.14)b 0.70 ÿ0.10$Traumatic stress disorder 3.89 (3.60) 3.13 (3.09)a 4.63 (3.90)b 0.80 ÿ0.13$Speci®c phobia, animal type 0.89 (1.33) 0.65 (1.15)a 1.13 (1.44)b 0.74 0.11$Speci®c phobia, blood-injection-injury type 3.78 (2.75) 3.11 (2.59)a 4.42 (2.76)b 0.68 ÿ0.13$Speci®c phobia, situational±environmental type 2.47 (2.20) 1.91 (1.95)a 3.00 (2.29)b 0.64 ÿ0.15$

SCARED-R=Screen for Child Anxiety Related Emotional Disorders, Revised. Means in the same row that do notshare the same subscripts di�er at P<0.005. $P<0.01.

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112106

Table 3Results of factor analysis (principal components, oblimin rotation) of the original SCARED (item numbers are

given between parentheses)

Factor 1 Factor 2 Factor 3 Factor 4 Factor 5

Panic disorderWhen frightened, it is hard to breathe (1) 0.58When frightened, I feel like passing out (9) 0.59

People tell me that I look nervous (14) 0.28 0.42When frightened, I feel like going crazy (18) 0.59When frightened, I feel that things are not real (27) 0.37 0.44

When frightened, my heart beats fast (32) 0.37 0.42I feel weak and shaky (35) 0.57When frightened, I sweat a lot (40) 0.46

I get really frightened for no reason (44) 0.58When frightened, I feel like I am choking (48) 0.73I am afraid of having anxiety attacks (51) 0.58

When frightened, I feel like throwing up (56) 0.57When frightened, I feel dizzy (60) 0.58

Generalized anxiety disorder

I worry about others not liking me (8) 0.61I am nervous (11) 0.38 0.40I worry about being as good as other kids (21) 0.60

I worry about things working out for me (38) 0.67I am a worrier (41) 0.63People tell me I worry too much (49) 0.61

I worry about the future (55) 0.66I worry about how well I do things (57) 0.57I worry about things that happened in the past (59) 0.41 0.48

Social phobiaI don't like to be with people I don't know (4) 0.61I feel nervous with people I don't know well (15) 0.74

I ®nd it hard to talk with people I don't know (47) 0.67I am shy with people I don't know well (53) 0.69

School phobiaI get headaches or stomach aches when I am at school (3) 0.50I don't like going to school (17) 0.32I worry about going to school (30) 0.53 0.39

I am scared to go to school (58) 0.53 0.38

Separation anxiety disorder

I get scared when I sleep away from home (7) 0.48I follow my parents wherever they go (13) 0.46I worry about sleeping alone (19) 0.61

I have nightmares about my parents (29) 0.29I have nightmares about bad happening to me (36) 0.46 0.25I am afraid to be alone at home (45) 0.66

I don't like being away from my family (50) 0.49 0.38I worry that bad happens to my parents (52) 0.57 0.42

Eigenvalue 8.45 1.91 1.86 1.47 1.32

% Explained variance 22.22 5.03 4.89 3.88 3.47

SCARED=Screen for Child Anxiety Related Emotional Disorders.

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112 107

<0.20 with total SCARED-R score, 6 items correlated <0.30, whereas the remaining 59 itemsall correlated substantially (i.e. >0.30) with total SCARED-R. A second order factor analysis(in which SCARED-R subscales scores are factor analyzed) also pointed in the direction of a1-factor solution: only 1 factor with an eigenvalue greater than 1.00 (i.e. 4.87) emerged. Thisfactor accounted for 52.06% of the variance. Taken together, the results of exploratory factoranalysis suggest that in this sample of normal children, the SCARED-R possesses a 1-factorstructure.Con®rmatory factor analyses were carried out to further examine the factor structure of the

SCARED-R. Three alternative models were investigated. The ®rst model examined the degreeto which all symptoms can be viewed as re¯ecting a single, homogeneous dimension of anxietyrather than a number of anxiety clusters (the 1-factor model). The second model postulatedthat the data would be explained by nine independent factors (the 9-uncorrelated-factorsmodel). The third and ®nal model also assumed 9 separate factors but allowed these factors tobe intercorrelated (the 9-correlated-factors model).Results of the con®rmatory factor analyses revealed the following goodness-of-®t values for

the 1-factor model: chi square/df=2.96, AASR=0.04 and CFI=0.66. For the 9-uncorrelatedfactors model, these values were: chi square/df=3.48, AASR=0.15 and CFI=0.56. For the9-correlated factors model, values were: chi square/df=2.26, AASR=0.05 and CFI=0.78.These results, in particular the insu�cient CFIs, indicate that none of the models provided asatisfactory ®t to the SCARED-R data.

3.3. Factor structure of the original 38-item SCARED

An additional principal components factor analysis with Oblimin rotation was conducted onthe 38 items of the original SCARED. Again, a very strong ®rst factor emerged, together with4 other factors with eigenvalues greater than 1.00. Table 3 displays the 38 SCARED items andtheir loadings on these 5 factors after rotation. As can be seen, most items loaded convincinglyon their supposed factor. Together, these ®ve factors accounted for 39.49% of the variance.Thus, in this sample of normal children, the factor structure of the original 38-item SCARED(Birmaher et al., 1997) was replicated.A con®rmatory factor analysis revealed that a 5-correlated-factors model provided the best

®t for the original SCARED. Goodness-of-®t indices were all satisfactory: chi square/df=2.45,AASR=0.04 and CFI=0.84.

3.4. Factor structure of the new SCARED-R speci®c phobia scales

A ®nal factor analysis was carried out on the 15 items of the SCARED-R that intend tomeasure speci®c phobias. Results revealed three factors with eigenvalues greater than 1.00,declaring 44.37% of the variance. Table 4 shows SCARED-R speci®c phobia items and theirloadings on the 3 factors. As expected, blood-injection-injury type items loaded convincinglyon the ®rst factor, animal type items on the second factor and situational±environmental typeitems on the third factor.A con®rmatory factor analysis indeed showed that the 3-factor model of the SCARED-R

speci®c phobia items was satisfactory: chi square/df=2.98, AASR=0.04 and CFI=0.90.

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112108

4. Discussion

The current study investigated the factor structure of the SCARED-R in a sample of normalschool children aged 8±13 years. Results of an exploratory factor analysis suggest that the 66-item SCARED-R primarily has a 1-factor structure. By means of con®rmatory factor analysis,several models for the SCARED-R (i.e. 1-factor model, 9-uncorrelated-factors model and 9-correlated-factors model) were tested. However, none of these models was found to besatisfactory. Additional exploratory and con®rmatory factor analyses carried out on parts ofthe SCARED-R provided some support for the presence of a number of anxiety symptomsclusters. To begin with, with the 38 original SCARED items the 5-factor structure (re¯ectingthe anxiety categories of panic disorder, generalized anxiety disorder, separation anxietydisorder, social phobia and school phobia) as found by Birmaher et al. (1997) was replicated,in spite of the fact that the latter study relied on a clinical sample. Furthermore, factor analysisperformed on the speci®c phobia items of the SCARED-R revealed three factors that ®t withthe subtypes that are listed in the DSM-IV (APA, 1994; see also Frederikson et al., 1996).Thus, as intended, SCARED-R speci®c phobia items can be grouped into three subscales,namely blood-injection-injury phobia, animal phobia and situational±environmental phobia.

Table 4Results of factor analysis (principal components, oblimin rotation) of the new SCARED-R speci®c phobia scales

(item numbers are given between parentheses)

Factor 1 Factor 2 Factor 3

Speci®c phobia, blood-injection-injury typeWhen I see blood, I get dizzy (5) 0.38I am afraid to visit the doctor (16) 0.74

I am afraid to visit the dentist (20) 0.66I am scared when I get an injection (33) 0.75I am afraid to get a serious disease (34) 0.36 0.40

I feel scared when I watch an operation (42) 0.51 0.47I don't like being in a hospital (66) 0.54

Speci®c phobia, animal typeI am afraid of an animal that is not really dangerous (22) 0.85I am so scared of a harmless animal that I do not dare to touch it (37) 0.81

I am afraid of an animal that most children do not fear (65) 0.76

Speci®c phobia, situational±environmental typeI am afraid of heights (2) 0.56I get scared when there is thunder in the air (23) 0.65

I feel scared when I have to ¯y in an aeroplane (28) 0.57I get scared in small, closed places (61) 0.66I am afraid of the dark (63) 0.67

Eigenvalue 3.98 1.54 1.22% Explained variance 25.97 10.29 8.11

SCARED-R=Screen for Child Anxiety Related Emotional Disorders, Revised.

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112 109

The present studies failed to ®nd a satisfactory factor structure for the complete SCARED-R. More speci®cally, both exploratory and con®rmatory factor analysis did not yield theexpected 9 factors representing the anxiety disorders spectrum as de®ned in the DSM. Onecould argue that this negative result is due to the fact that the present study relied on a sampleof normal children. It is still possible that in samples of clinically referred children, thehypothesized DSM-like factor structure of the SCARED-R will emerge. Future studies shouldaddress this issue. Furthermore, it should be noted that a good factor structure is not aconditio sine qua non of a measure's validity. The SCARED-R is closely linked to clinicalpractice which increasingly relies on the DSM for classifying anxiety and other mentaldisorders in children. Frequently employed childhood anxiety measures such as the STAIC, theRCMAS, and the FSSC-R do not have this direct link to DSM-de®ned diagnostic categories.Not surprisingly then, research has frequently shown that these traditional indices lackdiscriminant validity. That is, these questionnaires are unable to di�erentiate between anxietydisordered children and children with other types of psychopathology (e.g. Perrin and Last,1992). The SCARED-R is promising in this respect in that it seems to possess adequatediscriminant validity. Evidence for this comes from two sources. First, Birmaher et al. (1997)found that the original SCARED di�erentiates between anxiety disordered children, childrenwith depression, and children with disruptive disorders. Second, there is evidence to suggestthat the SCARED-R satisfactorily discriminates children with a speci®c anxiety disorder fromchildren without that particular anxiety disorder (Muris et al., submittedb).Using the SCARED-R in a sample of normal children, the current study replicated some

phenomena that previous surveys (relying on other instruments) have found to be very robust.First, as in other studies, girls were found to have higher anxiety scores than boys (see, for areview, Bernstein and Borchardt, 1991). Furthermore, age was inversely related to SCARED-Rscores. Again, this is in agreement with earlier studies that showed that anxiety symptomsdecline with age. In the present study, this age e�ect was most evident for separation anxietydisorder symptoms. Birmaher et al. (1997) also showed that especially separation anxietysymptoms are more common among younger children than among older children.Note that the present ®ndings (and those of Birmaher et al., 1997) suggest that school

phobia can best be treated as a distinct anxiety disorder. Although it is generally assumed thatthis type of phobia is predominantly linked to separation anxiety disorder (e.g. DSM-III-R;APA, 1987), several authors (Ollendick and Mayer, 1984; Atkinson et al., 1985; Bernstein andGar®nkel, 1986; Last and Francis, 1988) have noted that refusal to go to school can also pointin the direction of fear of a speci®c stimulus in the school setting (which would suggest thepresence of a speci®c phobia) and/or fear of certain social situations such as speaking in class(which would suggest the presence of social phobia).What do the present ®ndings mean for the use of the SCARED-R? Clearly, the original

SCARED (comprising the subscales panic disorder, separation anxiety disorder, generalizedanxiety disorder, social phobia, and school phobia) has reasonable psychometric propertiesand, consequently, seems to be an acceptable clinical or research tool. The same is true for theadded speci®c phobias scales of the SCARED-R. However, more research is required withregard to the traumatic stress disorder and the obsessive±compulsive disorder subscales of theSCARED-R. Although the traumatic stress disorder subscale might be valuable in clinicalsettings, more information is needed about what precisely this scale measures. For example,

P. Muris et al. / Personality and Individual Di�erences 26 (1999) 99±112110

what type of experiences do children refer to when they respond with ``sometimes'' or ``often''to items such as ``I get scared when I think back of a very aversive event I once experienced''?Much the same is true for the SCARED-R obsessive±compulsive disorder subscale. Futurestudies should compare this subscale with other instruments that measure this disorder inchildren, e.g. the child version of the Leyton Obsessional Inventory (LOI; Berg et al., 1986).

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