Spence Children’s Anxiety Scale – Parent (SCAS- Parent)

1. Abstract

The Spence Children’s Anxiety Scale – Parent Version (SCAS-Parent; Nauta et al., 2004) is a widely utilized, psychometrically validated parent-proxy rating instrument engineered to assess multidimensional anxiety symptomatology in children and adolescents aged 6 to 18 years. Developed as a collateral counterpart to the pioneering youth self-report Spence Children’s Anxiety Scale (SCAS; Spence, 1997, 1998), the SCAS-Parent evaluates anxiety presentations mapped closely onto the diagnostic classifications established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and conserved across DSM-5). The instrument comprises 38 closed-ended clinical items and one optional open-ended qualitative inquiry, scored across a 4-point Likert scale ranging from 0 (Never) to 3 (Always), yielding a cumulative Total Anxiety Score (maximum score of 114) and six correlated subscales: Separation Anxiety, Social Phobia, Obsessive-Compulsive Disorder, Panic Attack and Agoraphobia, Physical Injury Fears, and Generalized Anxiety Disorder.

Extensive psychometric investigations across international clinical and community cohorts substantiate the robust psychometric architecture of the SCAS-Parent. The seminal validation study by Nauta et al. (2004), comprising 484 parents of clinically diagnosed youth with anxiety disorders and 261 community controls, confirmed high internal consistency, with Cronbach’s alpha reaching .89 for the total score and varying between .61 and .87 across individual subscales. Confirmatory factor analyses (CFA) replicate a robust six-factor correlated model that mirrors the structural anatomy of the youth self-report version. The measure displays well-documented convergent validity against established instruments such as the Child Behavior Checklist (CBCL) Anxious/Depressed scale and the Screen for Child Anxiety Related Emotional Disorders (SCARED), discriminant validity separating anxious from depressive and externalizing profiles, and diagnostic utility using receiver operating characteristic (ROC) analyses. By providing parent-derived observational data, the SCAS-Parent serves as an indispensable tool in multi-informant assessment, clinical triaging, epidemiological screening, and longitudinal tracking of therapeutic outcomes in pediatric mental health.

2. Keywords

Spence Children’s Anxiety Scale, SCAS-Parent, pediatric anxiety assessment, parent-proxy report, multi-informant assessment, psychometrics, confirmatory factor analysis, separation anxiety, generalized anxiety disorder, child psychopathology

3. Authors

The Spence Children’s Anxiety Scale – Parent Version was developed and validated through an international research collaboration led by clinical psychologists and psychometricians:

• Sanne H. Nauta, Ph.D. — Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands. Specializes in cognitive-behavioral assessment and interventions for pediatric internalizing disorders.
• Anita Scholing, Ph.D. — Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands. Renowned for clinical research in childhood and adolescent social anxiety and phobias.
• Ronald M. Rapee, Ph.D., FASSA — Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia. Distinguished Professor of Psychology, internationally recognized for pioneering the etiology, theoretical conceptualization, and treatment of anxiety disorders across the lifespan.
• Maree J. Abbott, Ph.D. — School of Psychology, The University of Sydney, Sydney, Australia. Clinical psychologist with expertise in cognitive mechanisms underlying anxiety disorders.
• Susan H. Spence, Ph.D., AO — School of Applied Psychology and Australian Institute for Suicide Research and Prevention, Griffith University, Queensland, Australia. Emeritus Professor and original architect of the Spence Children’s Anxiety Scale (SCAS) family of instruments.
• Allison M. Waters, Ph.D. — School of Applied Psychology, Griffith University, Queensland, Australia. Senior academic researching developmental cognitive psychopathology and experimental therapeutics in pediatric anxiety.

4. Purpose

Anxiety disorders represent the most prevalent class of psychiatric conditions in childhood and adolescence, marked by significant longitudinal morbidity, scholastic underachievement, impaired peer socialization, and elevated risks for subsequent depressive and substance use disorders (Costello et al., 2005; Kessler et al., 2012). Accurate assessment of pediatric anxiety presents distinct clinical and developmental challenges. Young children frequently possess limited metacognitive awareness, constrained emotional vocabulary, or developmental difficulty reporting the frequency, intensity, and functional impact of internalizing distress. Conversely, parents observe behavioral avoidance, psychophysiological reactions, safety behaviors, and daily functional disruptions across multiple naturalistic contexts such as home, school drop-offs, and social gatherings. The Spence Children’s Anxiety Scale – Parent Version (SCAS-Parent) was purpose-built to address this critical diagnostic niche.

The primary clinical and empirical objectives of the SCAS-Parent comprise:

• Comprehensive Diagnostic Screening: Providing an empirically grounded, time-efficient inventory to evaluate the presence and severity of anxiety signs across six distinct syndromal dimensions aligned with DSM categories.
• Multi-Informant Assessment Architecture: Operationalizing evidence-based guidelines outlined by the American Psychological Association (APA) and the American Academy of Child and Adolescent Psychiatry (AACAP), which mandate collateral informant integration. Collating parent reports alongside child self-reports accounts for informant variance and provides a comprehensive assessment of youth functioning (De Los Reyes & Kazdin, 2005).
• Baseline Triage and Differential Diagnosis: Assisting clinicians in outpatient, inpatient, pediatric medical, and school mental health settings in determining whether a child’s aggregate distress crosses the clinical significance threshold (operationalized as scores at or exceeding the 84th percentile, or +1 standard deviation above the community mean), while identifying specific syndromal elevations.
• Treatment Outcome Evaluation: Serving as a sensitive, repeated-measurement instrument for tracking symptom attenuation, behavioral change, and therapeutic gains across pharmacological interventions and evidence-based psychological treatments, such as cognitive-behavioral therapy (CBT) programs like Cool Kids and Copending Cat.
• Epidemiological and Developmental Research: Offering a standardized measurement tool with robust psychometric invariance across sexes and developmental age brackets (ages 6–18 years), facilitating large-scale psychiatric epidemiology, behavioral genetics, and prospective cohort studies.

5. Psychological Construct

The SCAS-Parent evaluates childhood anxiety not as a homogenous unidimensional construct, but as a hierarchical, multifaceted psychological phenomenon. The overarching latent construct of Pediatric Anxiety is characterized by excessive, persistent, and developmentally inappropriate apprehension, autonomic physiological hyperarousal, catastrophic cognitive appraisal, and functional behavioral avoidance. The SCAS-Parent decomposes this overarching latent entity into six distinct, intercorrelated dimensions reflecting standard psychiatric taxonomy:

1. Separation Anxiety (Items 5, 8, 11, 14, 15, 38)

This dimension assesses excessive, developmentally inappropriate apprehension concerning real or anticipated separation from primary attachment figures or the home environment. Behavioral manifestations evaluated via parent observation include intense distress upon school arrival, difficulty remaining alone at home, refusal to sleep independently without parental co-presence in the room, persistent apprehension that catastrophic harm or illness will befall family members, and somatic complaints occurring prior to anticipated separations.

2. Social Phobia (Items 6, 7, 9, 10, 26, 31)

This subscale captures persistent, marked fear of social evaluative or performance situations in which the child is exposed to unfamiliar peers or adult scrutiny. Observable features captured by the parent include intense distress during academic examinations, reluctance or panic when speaking in front of peers or class groups, anxiety regarding using public restrooms, paralyzing fear of making a fool of oneself, hypervigilance regarding peer appraisal, and reluctance or fear when needing to ask others for help.

3. Obsessive-Compulsive Disorder (Items 13, 17, 24, 35, 36, 37)

Although OCD was recategorized into a separate diagnostic chapter in DSM-5, its phenomenological ties to anxiety remain clinically evident. This subscale measures recurrent, intrusive, distress-inducing thoughts, images, or impulses (obsessional phenomena) alongside repetitive, ritualized overt or covert behaviors that the child feels driven to execute to neutralize distress or avert a catastrophic outcome (compulsive phenomena). Parent-observable behaviors include persistent checking rituals (e.g., switches, door locks), repetitive motor acts (e.g., excessive hand-washing, ordering, arranging), and distress associated with intrusive thoughts or cognitive rituals.

4. Panic Attack and Agoraphobia (Items 12, 19, 21, 25, 27, 28, 30, 32, 34)

This dimension operationalizes unexpected surges of intense fear or discomfort (panic) coupled with apprehension regarding future attacks or avoidance of places where escape might prove difficult or embarrassing (agoraphobia). Specific parent-reported items assess spontaneous bouts of severe unprovoked fear, acute complaints of cardiovascular acceleration (palpitations, tachycardia), sudden trembling or shaking, unprovoked dizziness or presyncope, dyspnea or choking sensations, fear of losing control or going crazy, emetophobia (fear of vomiting), claustrophobic avoidance (small, enclosed spaces), and travel distress on public transit (cars, buses, trains).

5. Physical Injury Fears (Items 2, 16, 20, 22, 29)

Corresponding to the Specific Phobia category, this dimension gauges circumscribed, disproportionate fear evoked by specific natural, animal, or medical threat stimuli. Parent-rated indicators include fear of the dark, acute phobic reactions to domestic animals (e.g., dogs), fear of insects and spiders, aversion to medical or dental appointments, and acute dread or vasovagal sensitivity to the sight of blood.

6. Generalized Anxiety Disorder (Items 1, 3, 4, 18, 23, 33)

Reflecting chronic, pervasive, and uncontrollable worry across diverse life domains (formerly conceptualized as Overanxious Disorder of Childhood). This subscale assesses diffuse apprehensions concerning past occurrences, future events, personal competence, and health. Somatic expressions include autonomic tension, subjective complaints of “funny feelings” or discomfort in the stomach, pervasive feelings of fearfulness without distinct situational triggers, motor restlessness, and worry regarding committing embarrassing blunders.

6. Theoretical Framework

The architecture and clinical operationalization of the SCAS-Parent are grounded in several intersecting theoretical paradigms within developmental psychopathology and clinical psychology:

Cognitive-Behavioral Models of Anxiety

The instrument draws directly from the cognitive formulations of anxiety articulated by Aaron Beck and expanded by David M. Clark and Ronald Rapee. Central to this theoretical framework is the tenet that anxiety disorders are driven by systematic cognitive processing biases, including selective attentional allocation toward threat-relevant stimuli, hypervigilance, and exaggerated appraisals of threat probability and cost, paired with low perceived self-efficacy and coping capacity (Beck & Clark, 1997). In children, these cognitive distortions manifest behaviorally through avoidance conditioning, safety-seeking behaviors, and physiological distress, all of which parents can systematically observe and quantify.

Barlow’s Triple Vulnerability Theory

David H. Barlow’s Triple Vulnerability Model posits that anxiety disorders emerge from the confluence of three etiological factors: a general biological vulnerability (heritable neurobiological reactivity and behavioral inhibition), a generalized psychological vulnerability (an early developmental sense of events being uncontrollable and unpredictable), and a specific psychological vulnerability (early learning experiences that channel anxiety toward specific stimuli or internal states, such as somatic sensations or social evaluation) (Barlow, 2002). The factor structure of the SCAS-Parent reflects this etiology: a shared general vulnerability accounts for the strong intercorrelations among subscales, while distinct specific vulnerabilities shape distinct syndromes like Panic, Separation Anxiety, and Social Phobia.

Rachman’s Three Pathways to Fear Acquisition

Jack Rachman (1977) proposed that fears develop through direct classical conditioning, vicarious acquisition (observational modeling), and informational transmission. The parent-proxy format captures behaviors shaped across all three pathways. Parents observe how children react following conditioned negative encounters (e.g., animal bites, medical procedures) and track the behavioral manifestations of modeled or verbally transmitted threat representations within the familial environment.

Attachment Theory and Developmental Psychopathology

For the Separation Anxiety subscale, the theoretical framework integrates John Bowlby’s attachment theory. Bowlby emphasized that secure attachment provides an exploratory base; insecure-ambivalent or resistant attachment histories often predispose children to exaggerated separation fears, catastrophic separation ideation, and sleep resistance when facing normative developmental autonomy demands (Bowlby, 1973).

Multi-Informant Discrepancy Theory

Psychometric theory regarding multi-informant assessment (De Los Reyes & Kazdin, 2005) highlights that discrepancies between parent and child reports are not merely measurement error, but reflect meaningful variance across observational contexts. While children have direct access to private internalizing states (e.g., subjective dread, covert obsessions), parents provide unique observational perspective on overt behavioral avoidance, functional disruption, comparative developmental deviance, and family-system impacts. The SCAS-Parent operationalizes this collateral perspective using standardized psychometric benchmarks.

7. Validity

Extensive psychometric investigations across clinical, community, and cross-cultural cohorts provide robust evidence for the construct, convergent, discriminant, and predictive validity of the SCAS-Parent.

Construct and Factorial Validity

In the foundational validation investigation conducted by Nauta, Scholing, Rapee, Abbott, Spence, and Waters (2004), the psychometric properties were evaluated across a clinical sample of 484 parents of children diagnosed with DSM-IV anxiety disorders (recruited through specialized anxiety clinics in Australia and the Netherlands) and a non-clinical community sample of 261 parents. Confirmatory factor analysis verified that a six-factor model corresponding to the clinical subscales fit the empirical parent-report data significantly better than alternate single-factor or orthogonal models. This structural validity has been replicated across international adaptations, including German (Essau et al., 2002), Japanese (Ishikawa et al., 2009), Italian (Magi et al., 2017), and Spanish cohorts, demonstrating cross-cultural construct invariance.

Convergent Validity

The SCAS-Parent demonstrates robust, statistically significant correlations with alternative, well-validated youth anxiety batteries:

• Child Behavior Checklist (CBCL): The SCAS-Parent Total Anxiety Score displays strong, positive correlations with the CBCL Anxious/Depressed syndrome scale (r = .68 to .74, p < .001) and the broader Internalizing Problems broad-band scale (r = .65 to .71), indicating substantial convergence on core internalizing constructs (Nauta et al., 2004).
• Screen for Child Anxiety Related Disorders (SCARED): High concurrent associations are observed between corresponding subscales of the SCAS-Parent and the parent-report SCARED (correlations ranging from r = .72 to .81, p < .001).
• Clinician Severity Ratings (CSR): Subscale scores correlate significantly with clinician-administered Anxiety Disorders Interview Schedule for Children (ADIS-C/P) severity indices, confirming that parent-reported item endorsements track formal diagnostic severity ratings.

Discriminant and Divergent Validity

The scale effectively differentiates anxiety from distinct, non-anxiety psychiatric domains:

• Separation from Externalizing Psychopathology: Correlations between the SCAS-Parent Total Score and CBCL Externalizing Problems (e.g., Rule-Breaking Behavior, Aggressive Behavior) remain modest to low (r = .18 to .28), demonstrating clear divergence from disruptive behavioral phenotypes.
• Differentiation from Depressive Symptoms: While moderately correlated with depressive symptom indices due to shared negative affectivity (e.g., Children’s Depression Inventory [CDI] parent ratings, r = .45 to .52), multiple regression and structural modeling verify that the SCAS-Parent subscales account for unique, incremental variance in anxiety diagnoses beyond shared depressive variance.
• Clinical vs. Community Differentiation: The SCAS-Parent exhibits strong clinical discrimination. Nauta et al. (2004) demonstrated that children with diagnosed anxiety disorders scored markedly higher on the Total Scale and individual subscales compared to non-clinical controls (e.g., Total Score Clinical M = 35.2, SD = 17.6 vs. Control M = 14.8, SD = 10.9; Cohen’s d > 1.40, indicating very large effect sizes).

Predictive and Treatment Sensitivity Validity

The SCAS-Parent demonstrates high sensitivity to therapeutic change across longitudinal cognitive-behavioral trials (e.g., Rapee et al., 2006). Reductions in SCAS-Parent scores systematically correlate with diagnostic remission, decreases in clinician severity ratings, and reductions in functional impairment following treatment, confirming its utility as an outcome monitoring measure.

8. Reliability

Psychometric evaluations across international trials consistently confirm that the SCAS-Parent possesses high internal consistency, acceptable-to-strong temporal stability, and expected parent-child inter-informant concordance patterns.

Internal Consistency

Across validation cohorts, internal consistency metrics (Cronbach’s alpha [α] and McDonald’s omega [ω]) reach high levels for both the aggregate score and individual subscales:

• Total Anxiety Score: Demonstrates high internal consistency across both clinical (α = .89 to .92) and community samples (α = .88 to .90; Nauta et al., 2004; Whiteside et al., 2012).
• Panic Attack and Agoraphobia: α = .81 to .87, reflecting high item coherence across autonomic and situational items.
• Separation Anxiety: α = .76 to .83, confirming cohesive measurement of separation-related avoidance and distress.
• Social Phobia: α = .78 to .84, demonstrating uniform assessment of social evaluative fears.
• Generalized Anxiety: α = .77 to .83, evidencing solid reliability in capturing diffuse worry and somatic tension.
• Obsessive-Compulsive: α = .72 to .80, indicating consistent endorsement across obsessional and compulsive indicators.
• Physical Injury Fears: α = .61 to .68. This subscale displays somewhat lower internal consistency, which is developmentally expected given the stimulus-specific nature of phobic triggers (e.g., a child may fear dogs without necessarily fearing the dark or medical procedures).

Temporal Stability (Test-Retest Reliability)

Temporal stability evaluated via Intraclass Correlation Coefficients (ICC) and Pearson correlation coefficients across untreated non-clinical cohorts demonstrates sound longitudinal consistency. Across a 3- to 4-week interval, test-retest reliability for the Total Score remains robust (r = .81 to .85). Across longer intervals (e.g., 10 to 12 weeks), stability remains adequate (r = .68 to .74), indicating that the instrument captures stable trait-like dispositional anxiety while retaining sensitivity to genuine clinical shifts over time.

Inter-Informant Concordance

Parent-child agreement coefficients (correlating the SCAS-Parent with the youth self-report SCAS) conform to established empirical patterns in multi-informant assessment literature:

• Clinical Cohorts: Bivariate correlations between parent and child total scores range from r = .41 to .66 (p < .001; Nauta et al., 2004), demonstrating moderate-to-substantial concordance when symptoms cross functional impairment thresholds.
• Community Cohorts: Correlations are typically lower, ranging from r = .23 to .60, reflecting greater divergence in normative samples where internalizing distress is less overt.
• Inter-Parent Agreement: Maternal and paternal ratings show strong inter-rater reliability, with Pearson coefficients ranging between r = .64 and .78 for the total score.

9. Factor Analysis

The structural dimensionality of the SCAS-Parent has been thoroughly investigated through both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), using structural equation modeling across varied clinical and demographic groups.

Confirmatory Factor Analytic Findings

In the seminal psychometric investigation by Nauta et al. (2004), competitive model testing evaluated three alternative structural configurations:

1. A Unidimensional Model forcing all 38 items onto a single latent anxiety dimension.
2. An Orthogonal Six-Factor Model specifying six independent, uncorrelated anxiety dimensions.
3. A Correlated Six-Factor Model specifying six intercorrelated latent factors representing Separation Anxiety, Social Phobia, Obsessive-Compulsive Disorder, Panic/Agoraphobia, Physical Injury Fears, and Generalized Anxiety Disorder.

The empirical findings revealed that the Correlated Six-Factor Model provided the best fit to the data across both clinical and non-clinical groups, substantially outperforming alternative models:

• Clinical Sample Fit Indices: χ²/df = 1.94, Root Mean Square Error of Approximation (RMSEA) = .044 (90% CI [.041, .047]), Comparative Fit Index (CFI) = .93, Tucker-Lewis Index (TLI) = .92.
• Community Sample Fit Indices: χ²/df = 1.68, RMSEA = .049 (90% CI [.044, .054]), CFI = .91, TLI = .90.

Higher-Order and Bifactor Structures

Subsequent psychometric investigations (e.g., Whiteside et al., 2012; Brown-Jacobsen et al., 2011) examined whether a hierarchical higher-order model (where a single broad General Anxiety second-order latent trait accounts for the variance among the six primary factors) or a bifactor model better conceptualizes the instrument’s architecture. Results confirmed that a higher-order general factor exhibits high structural validity, supporting the clinical reporting and interpretation of both the broad Total Anxiety Score and the six individual subscale scores.

Factor Loadings and Latent Intercorrelations

Standardized item factor loadings across the six latent dimensions are generally substantial, with the vast majority of items loading between .45 and .82 on their designated latent factors. Inter-factor correlations among the latent dimensions are moderate to high, ranging from r = .38 (between Physical Injury Fears and Obsessive-Compulsive Disorder) to r = .78 (between Generalized Anxiety Disorder and Panic/Agoraphobia). These intercorrelations support Barlow’s formulation of shared underlying neuroticism and biological-psychological vulnerabilities across anxiety subtypes.

10. Instrument / Measurement Tool

The operational features, administration parameters, and scoring protocols of the SCAS-Parent are structured as follows:

• Instrument Designation: Spence Children’s Anxiety Scale – Parent Version (SCAS-Parent).
• Target Population: Parents, legal guardians, or primary caregivers of children and adolescents aged 6 to 18 years.
• Administration Format: Standardized parent-proxy questionnaire, available in paper-and-pencil or digital formats.
• Completion Duration: Approximately 8 to 12 minutes.
• Total Item Inventory: 39 total items (38 scored clinical anxiety items, plus 1 qualitative open-ended item).
• Response Scale: 4-point Likert scale formatted with authentic options:
  • 0 = Never
  • 1 = Sometimes
  • 2 = Often
  • 3 = Always
• Subscale Item Composition:
  • Separation Anxiety: Items 5, 8, 11, 14, 15, 38 (6 items; score range: 0–18).
  • Social Phobia: Items 6, 7, 9, 10, 26, 31 (6 items; score range: 0–18).
  • Obsessive-Compulsive: Items 13, 17, 24, 35, 36, 37 (6 items; score range: 0–18).
  • Panic/Agoraphobia: Items 12, 19, 21, 25, 27, 28, 30, 32, 34 (9 items; score range: 0–27).
  • Physical Injury Fears: Items 2, 16, 20, 22, 29 (5 items; score range: 0–15).
  • Generalized Anxiety: Items 1, 3, 4, 18, 23, 33 (6 items; score range: 0–18).
• Qualitative Item: Item 39 (“Is there anything else that your child is really afraid of?”) is an unrated qualitative item utilized for idiosyncratic fear profiling.
• Scoring and Transformation Algorithms:
  • All 38 scored items are coded directly from 0 to 3. There are no reverse-scored items.
  • Subscale scores are calculated by summing the numerical ratings of designated items within each dimension.
  • The Total Anxiety Score is calculated by summing all 38 items (cumulative score range: 0 to 114).
  • Raw scores can be converted into standardized T-scores (Mean = 50, SD = 10) and normative percentile ranks based on normative data stratified by child age and biological sex (Nauta et al., 2004).
• Clinical Cutoff and Interpretive Thresholds:
  • Subclinical / Typical Range: Total and subscale scores below the 84th percentile (T-score < 60).
  • Elevated / Clinically Significant Range: Scores falling at or above the 84th percentile (T-score ≥ 60, corresponding to +1 standard deviation above the community normative mean) indicate clinically significant anxiety warranting comprehensive diagnostic assessment.
  • Markedly Elevated Range: Scores falling at or above the 98th percentile (T-score ≥ 70, +2 standard deviations above the mean) indicate severe anxiety symptoms with high probability of functional impairment.

11. Permissions & Fee and Test Year

The Spence Children’s Anxiety Scale – Parent Version was developed and validated in 2004 following the publication of the original youth self-report version (Spence, 1997, 1998). In alignment with the developer’s commitment to advancing global child mental health assessment, the SCAS-Parent is an open-access psychometric instrument.

• User Permissions and Access: The scale is freely accessible for non-commercial clinical, educational, and academic research applications without royalty fees. Clinicians, school psychologists, and academic researchers may download, administer, and score the instrument without purchasing commercial test kits.
• Official Repository: Standardized assessment forms, comprehensive multi-language translations, automated scoring sheets, and normative tables are maintained on the official Spence Children’s Anxiety Scale website at www.scaswebsite.com.
• Intellectual Property and Copyright: Copyright is held by Professor Susan H. Spence and co-investigators (2004). Commercial redistribution, integration into proprietary fee-for-service software platforms, or publication within commercial packages requires explicit written licensing permission from the copyright holders.

12. References

• Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). Guilford Press.
• Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35(1), 49–58. https://doi.org/10.1016/S0005-7967(96)00069-1
• Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. Basic Books.
• Brown-Jacobsen, A. M., Wallace, K. M., & Whiteside, S. P. (2011). Multimethod, multi-informant agreement in pediatric obsessive-compulsive disorder, generalized anxiety disorder, and social phobia. Journal of Psychopathology and Behavioral Assessment, 33(3), 338–347. https://doi.org/10.1007/s10862-011-9233-y
• Costello, E. J., Egger, H., & Angold, A. (2005). 10-year research update review: The epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child & Adolescent Psychiatry, 44(10), 972–986. https://doi.org/10.1097/01.chi.0000172552.41596.6f
• De Los Reyes, A., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: A critical review, theoretical framework, and recommendations for further study. Psychological Bulletin, 131(4), 483–509. https://doi.org/10.1037/0033-2909.131.4.483
• Essau, C. A., Sakano, Y., Ishikawa, S., & Sasagawa, S. (2002). Anxiety symptoms in Japanese and German children. Behaviour Research and Therapy, 40(6), 601–612. https://doi.org/10.1016/S0005-7967(01)00078-X
• Ishikawa, S., Shimotsu, S., Ono, T., Sasagawa, S., Spence, S. H., & Sakano, Y. (2009). A parent-report measure of children’s anxiety: Psychometric properties of the Japanese version of the Spence Children’s Anxiety Scale-Parent Version. Japanese Journal of Behavior Therapy, 35(1), 17–28.
• Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of DSM-IV disorders in the National Comorbidity Survey Replication. International Journal of Methods in Psychiatric Research, 21(3), 169–184. https://doi.org/10.1002/mpr.1359
• Magi, A., Camisasca, E., & Di Blasio, P. (2017). The Spence Children’s Anxiety Scale Parent Version: A study of its psychometric properties with an Italian community sample. TPM-Testing, Psychometrics, Methodology in Applied Psychology, 24(4), 583–597. https://doi.org/10.4473/TPM24.4.7
• Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M. J., Spence, S. H., & Waters, A. M. (2004). A parent-report measure of children’s anxiety: Psychometric properties and comparison with children’s self-ratings in a sample of children with anxiety disorders. Behaviour Research and Therapy, 42(7), 813–839. https://doi.org/10.1016/S0005-7967(03)00200-6
• Rachman, S. (1977). The conditioning theory of fearacquisition: A critical examination. Behaviour Research and Therapy, 15(5), 375–387. https://doi.org/10.1016/0005-7967(77)90041-9
• Rapee, R. M., Abbott, M. J., & Lyneham, H. J. (2006). Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 436–444. https://doi.org/10.1037/0022-006X.74.3.436
• Spence, S. H. (1997). Structure of anxiety symptoms, symptoms, and anxiety disorders: A confirmatory factor analytic study of children’s anxiety. Journal of Abnormal Psychology, 106(2), 280–297. https://doi.org/10.1037/0021-843X.106.2.280
• Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36(5), 545–566. https://doi.org/10.1016/S0005-7967(98)00034-5
• Whiteside, S. P., Gryczkowski, M. R., Ale, C. M., Brown-Jacobsen, A. M., & McCarthy, D. M. (2012). Factor analysis of the Spence Children’s Anxiety Scale in a clinical sample of children and adolescents. Journal of Anxiety Disorders, 26(3), 460–467. https://doi.org/10.1016/j.janxdis.2012.01.007

13. Items of the Scale (Questionnaire)