Spence Children’s Anxiety Scale (SCAS)

1. Abstract

The Spence Children’s Anxiety Scale (SCAS) is an internationally recognized, empirically validated psychological assessment instrument engineered to evaluate the severity and frequency of anxiety symptoms in youth. Originally developed by Susan H. Spence in 1997 and 1998, the SCAS was created to address a critical psychometric gap in pediatric assessment: the lack of self-report measures directly aligned with the diagnostic taxonomy of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-5). Comprising 44 self-report items administered on a 4-point Likert-type frequency scale (0 = Never to 3 = Always), the instrument measures 38 specific anxiety symptoms mapped across six discrete clinical dimensions alongside six positive filler items designed to mitigate negative response bias. The six diagnostic dimensions encompass: (1) Separation Anxiety, (2) Social Phobia, (3) Obsessive-Compulsive Disorder, (4) Panic Disorder and Agoraphobia, (5) Generalized Anxiety Disorder, and (6) Physical Injury Fears (Specific Phobia).

Extensive normative validation was initially established on an epidemiologically representative cohort of 2,052 primary school children aged 8 to 12 years in Brisbane, Australia. Confirmatory factor analyses (CFA) have consistently replicated a hierarchical structural model wherein six distinct first-order anxiety factors load significantly onto a single higher-order general anxiety factor. Psychometrically, the SCAS demonstrates robust internal consistency, yielding Cronbach’s alpha coefficients of .92 to .93 for the total anxiety scale and acceptable-to-strong reliability across individual subscales (.60 to .82). Six-month test-retest reliability stands at .60 for community samples, reflecting typical developmental symptom fluctuation while preserving clinical diagnostic utility. Criterion, convergent, and discriminant validity have been confirmed against gold-standard measures such as the Revised Children’s Manifest Anxiety Scale (RCMAS), the Child Behavior Checklist (CBCL), and structured clinical psychiatric interviews. With established parent-report, preschool, and adolescent adaptations, the SCAS serves as an essential open-access screening and outcome-monitoring instrument across clinical, educational, and epidemiological contexts worldwide.

2. Keywords

Spence Children’s Anxiety Scale, SCAS, pediatric anxiety assessment, child psychopathology, separation anxiety disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, panic disorder, agoraphobia, physical injury fears, psychometrics, DSM-IV anxiety disorders.

3. Authors

The Spence Children’s Anxiety Scale was developed by Susan H. Spence, AO, PhD, DipClinPsych. Dr. Spence is an internationally renowned clinical psychologist and psychometrician, currently serving as Professor Emeritus at the School of Applied Psychology and the Australian Institute for Suicide Research and Prevention (AISRAP) at Griffith University (Queensland, Australia). She previously held prominent academic leadership roles at the University of Queensland and the University of Sydney.

Throughout her career, Dr. Spence focused her empirical scholarship on the etiology, assessment, prevention, and cognitive-behavioral treatment of pediatric internalizing disorders, notably childhood and adolescent anxiety and depressive conditions. Her research in developing the SCAS was conducted in collaboration with distinguished clinical child researchers, including Ronald M. Rapee, Paula M. Barrett, and Cynthia M. Turner. Subsequent structural validations and cross-informant adaptations involved key international collaborators such as Sanne Nauta and Peter Muris.

4. Purpose

The primary clinical and empirical objective of the Spence Children’s Anxiety Scale is to provide a reliable, dimensionally sensitive, and clinically actionable self-report assessment of pediatric anxiety symptoms. Prior to the introduction of the SCAS in the late 1990s, existing pediatric anxiety instruments—such as the Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978) and the State-Trait Anxiety Inventory for Children (STAIC; Spielberger, 1973)—suffered from major structural and theoretical constraints. These legacy instruments conceptualized anxiety as a largely undifferentiated, unidimensional construct or represented downward adaptations of adult self-report inventories. Consequently, they failed to capture the multifaceted, syndrome-specific clinical profiles formalized within contemporary psychiatric classification systems.

Spence designed the SCAS to align with the diagnostic architecture of the DSM-IV, ensuring that childhood anxiety assessment corresponds directly to specific clinical conditions such as Separation Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Agoraphobia, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, and Specific Phobias. The instrument was constructed to serve three interdependent applications across academic, school, and healthcare settings:

• Universal and Targeted Screening: The SCAS enables public health researchers, school psychologists, and community practitioners to rapidly identify children exhibiting elevated anxiety symptoms who are at imminent risk of developing impairing internalizing psychopathology.
• Diagnostic Triangulation: Within specialized outpatient and inpatient child psychiatry and clinical psychology clinics, the SCAS functions as a multidimensional adjunctive assessment that complements structured diagnostic interviews, such as the Anxiety Disorders Interview Schedule for Children (ADIS-C) and the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).
• Treatment Progress and Outcome Monitoring: Owing to its continuous dimensional scoring properties, the SCAS provides a sensitive measure of symptom reduction, cognitive restructuring, and behavioral habituation across manualized cognitive-behavioral interventions (such as the Coping Cat or FRIENDS programs) and pharmacological clinical trials.

Importantly, the scale incorporates six positive filler items to disrupt negative cognitive priming and alleviate evaluation apprehension, making it developmentally attuned to the cognitive and emotional capacities of youth aged 8 to 12 years.

5. Psychological Construct

The Spence Children’s Anxiety Scale is grounded in a multidimensional conceptualization of anxiety in children. Rather than treating anxiety as an amorphous internalizing state, the SCAS delineates six distinct psychopathological domains alongside positive buffer mechanisms. Each domain reflects specific cognitive, behavioral, physiological, and emotional symptoms:

Separation Anxiety Disorder (SAD)

Comprising 6 items (e.g., Item 5: “I would feel afraid of being on my own at home”; Item 8: “I worry about being away from my parents”; Item 15: “I feel scared if I have to sleep on my own”), this subscale evaluates developmentally inappropriate, excessive distress regarding real or anticipated separation from primary attachment figures. The items capture behavioral resistance to sleeping alone, distress during parental absence, anticipatory dread regarding catastrophic harm befalling family members, and school refusal stemming from separation distress.

Social Phobia / Social Anxiety Disorder (SoP)

Evaluated through 6 items (e.g., Item 6: “I feel scared when I have to take a test”; Item 9: “I feel afraid that I will make a fool of myself in front of people”; Item 34: “I feel afraid if I have to talk in front of my class”), this construct captures marked fear and avoidance of social evaluative situations. It targets core cognitive distortions such as fear of negative peer evaluation, public embarrassment, stage fright, and physiological apprehension in structured academic or social environments.

Obsessive-Compulsive Disorder (OCD)

Measured via 6 items (e.g., Item 14: “I have to keep checking that I have done things right (like the switch is off, or the door is locked)”; Item 26: “I have to think of special thoughts to stop bad things from happening (like numbers or words)”; Item 39: “I have to do some things over and over again”), this dimension reflects recurrent, intrusive ego-dystonic thoughts (obsessions) and repetitive neutralizing behaviors or mental acts (compulsions). The items target checking rituals, cleaning compulsions, superstitious counting, and symmetry/ordering demands intended to prevent hypothetical harm.

Panic Disorder and Agoraphobia (PD/AG)

Assessed through 9 items (e.g., Item 13: “I suddenly feel as if I can’t breathe when there is no reason for this”; Item 21: “I suddenly start to tremble or shake when there is no reason for this”; Item 29: “I am afraid of being in crowded places”), this subscale captures sudden, unprovoked surges of intense autonomic arousal alongside anticipatory fears of recurrent attacks. Symptoms encompass tachycardia, hyperventilation, dizziness, trembling, and subsequent agoraphobic avoidance of crowded public venues, enclosed spaces, and public transit.

Generalized Anxiety Disorder (GAD)

Comprising 6 items (e.g., Item 1: “I worry about things”; Item 3: “When I have a problem, I get a funny feeling in my stomach”; Item 20: “When I have a problem, my heart beats really fast”), this domain measures pervasive, uncontrollable, and diffuse worry regarding diverse everyday life domains, academic performance, and future events. Somatic manifestations such as visceral abdominal distress, muscle tension, and autonomic reactivity during problem-solving situations are central features of this construct.

Physical Injury Fears (Specific Phobia)

Evaluated across 5 items (e.g., Item 2: “I am scared of the dark”; Item 18: “I am scared of dogs”; Item 22: “I am scared of going to the doctors or dentists”; Item 32: “I am scared of insects or spiders”), this factor reflects acute animal, environmental, and medical phobias. It represents evolutionary prepotent fears concerning bodily harm, darkness, dangerous animals, and medical interventions.

Positive Buffer Items

The scale integrates 6 positively valenced items (e.g., Item 11: “I am popular amongst other kids my own age”; Item 30: “I feel happy”; Item 37: “I like myself”). These items are not included in the anxiety scoring algorithm; they serve to interrupt perseverative negative response sets, support positive self-worth during assessment, and reduce defensive response styles.

6. Theoretical Framework

The conceptual architecture of the SCAS is rooted in the intersection of cognitive-behavioral theory, developmental psychopathology, and structural nosology. The scale is built upon several foundational frameworks in child clinical psychology:

Cognitive-Behavioral Formulations of Childhood Anxiety

In accordance with cognitive models developed by Aaron T. Beck and expanded by Ronald M. Rapee, anxious youth exhibit systematic cognitive processing biases. These biases manifest as the hyper-vigilant detection of threat cues, inflated estimates of threat probability and severity, and an underestimation of personal coping resources and external support systems. The SCAS operationalizes these cognitive distortions across domain-specific worry scenarios (e.g., catastrophizing about family separation, fear of negative social scrutiny, obsessive neutralizing thoughts), reflecting the internal dialogue characteristic of cognitive schemas in anxious youth.

Developmental Psychopathology and Attachment Paradigms

The SCAS incorporates developmental principles regarding the normative emergence, peak, and maturation of specific fears throughout childhood. Grounded in attachment theory (Bowlby, 1969) and developmental psychopathology frameworks (Cicchetti & Sroufe, 2000), the instrument acknowledges that fear of the dark and physical injury fears typically peak during early childhood, separation anxiety reaches prominence during middle childhood, and social evaluative concerns and panic symptoms emerge more frequently during late childhood and early adolescence. By isolating these six symptom categories, the scale enables researchers and clinicians to evaluate whether an observed fear pattern is developmentally normative or indicative of clinical severity.

Hierarchical and Tripartite Structural Models

From a psychometric and structural perspective, the SCAS operationalizes the hierarchical organization of internalizing psychopathology, congruent with Clark and Watson’s (1991) Tripartite Model and David Barlow’s Triple Vulnerability Theory. This framework posits that childhood anxiety comprises:

1. A broad, higher-order latent vulnerability characterized by generalized negative affectivity, neuroticism, and physiological hyperarousal.
2. Lower-order, etiologically distinct phenotypic manifestations that differentiate into specific phobic, panic, social, obsessive, and separation patterns based on environmental learning, cognitive appraisal styles, and genetic conditioning.

The SCAS preserves both levels of this hierarchy by generating an overarching Total Anxiety score alongside six discrete subscale indices.

7. Validity

The empirical validity of the Spence Children’s Anxiety Scale has been established through extensive psychometric investigations involving community, school-based, and clinical samples worldwide.

Construct and Structural Validity

Construct validity was established in Spence’s foundational 1997 and 1998 investigations through rigorous confirmatory factor analysis (CFA) conducted on a community cohort of 2,052 children. Testing competing structural configurations demonstrated that a six-factor hierarchical model—where six first-order factors load onto a single higher-order general anxiety factor—exhibited superior goodness-of-fit indices compared to alternative single-factor or uncorrelated multi-factor models. This hierarchical configuration has been replicated across international psychometric studies in Europe, Asia, North America, and the Middle East, confirming cross-cultural construct invariance.

Convergent Validity

The SCAS demonstrates robust convergent validity against standard pediatric anxiety instruments:

• Revised Children’s Manifest Anxiety Scale (RCMAS): The SCAS Total Anxiety score correlates strongly with the RCMAS total score, with Pearson coefficients typically ranging from r = .71 to .75 (Spence, 1998; Muris et al., 2000).
• Multidimensional Anxiety Scale for Children (MASC): Convergent correlations between corresponding subscales of the SCAS and MASC (e.g., social anxiety and separation anxiety) range between r = .64 and .78.
• Child Behavior Checklist (CBCL): The SCAS correlates substantially with the CBCL Internalizing Problems scale (r = .58 to .66), while exhibiting lower associations with the CBCL Externalizing Problems scale (r = .22 to .31), establishing concurrent discriminant validity.

Discriminant and Criterion-Related Validity

The instrument reliably differentiates clinically referred children with diagnosed anxiety disorders from non-clinical community controls and youth with non-anxiety psychiatric diagnoses (such as conduct disorder or ADHD). Children diagnosed with specific anxiety disorders through structured clinical interviews (e.g., ADIS-C) score significantly higher on corresponding SCAS subscales than on unrelated subscales, demonstrating diagnostic specificity. While moderate correlations exist between the SCAS and childhood depression indices (e.g., Children’s Depression Inventory [CDI], with coefficients around r = .50 to .58), these reflect the known comorbidity between negative affect syndromes rather than conceptual overlap.

Cross-Cultural and Longitudinal Validity

The SCAS has been translated and psychometrically validated in over 30 languages, including Dutch (Nauta et al., 2004), German (Essau et al., 2002), Persian (Mousavi et al., 2007), Japanese (Ishikawa et al., 2009), and Spanish. Across these diverse settings, the factor structure, factor loadings, and diagnostic cutoff profiles remain largely consistent.

8. Reliability

The SCAS exhibits strong reliability across indices of internal consistency, composite reliability, and temporal stability:

Internal Consistency

In the primary normative standardization study (Spence, 1998; N = 2,052), the 38-item Total Anxiety score yielded an overall Cronbach’s alpha of .92, indicating excellent internal consistency. Subscale alpha coefficients in community and clinical samples show acceptable to strong values:

• Panic Disorder and Agoraphobia: α = .82
• Generalized Anxiety Disorder: α = .73
• Obsessive-Compulsive Disorder: α = .73
• Separation Anxiety Disorder: α = .70
• Social Phobia: α = .70
• Physical Injury Fears: α = .60

The somewhat lower internal consistency for the Physical Injury Fears subscale (α = .60) reflects the heterogeneity of specific phobic stimuli (e.g., dogs, medical settings, dark rooms, insects), which do not always co-occur within the same individual.

Test-Retest Stability

Temporal stability was evaluated by Spence (1998) in a subsample of 344 children reassessed over a 6-month test-retest interval. The total score demonstrated a stability coefficient of r = .60, indicating moderate-to-good stability over an extended developmental timeframe. Re-testing across shorter clinical intervals (2 to 4 weeks) has yielded higher test-retest reliability coefficients ranging between r = .75 and .86, confirming the scale’s stability in the absence of therapeutic intervention.

9. Factor Analysis

The factorial validity of the SCAS was established through exploratory (EFA) and confirmatory factor analytic (CFA) procedures to resolve whether childhood anxiety is best conceptualized as a unitary dimension, a series of independent disorders, or a hierarchical system.

Initial CFA Specifications and Fit Indices

In Spence’s landmark 1997 study (Journal of Abnormal Psychology), CFA was conducted on maximum-likelihood covariance matrices derived from 2,052 school children. Four competing structural models were formally evaluated:

1. A single general factor model representing undifferentiated anxiety.
2. A six-factor orthogonal model assuming independent, uncorrelated anxiety disorders.
3. A six-factor correlated model allowing the six clinical dimensions to covary freely.
4. A hierarchical second-order model in which a single general higher-order anxiety construct accounts for the shared variance among the six first-order clinical factors.

The single-factor and orthogonal models showed poor fit to the empirical data (χ²/df > 5.0, RMSEA > .08, CFI < .80). In contrast, the hierarchical second-order model demonstrated strong fit indices:

• Root Mean Square Error of Approximation (RMSEA): ≤ .045 (indicating close approximate fit)
• Comparative Fit Index (CFI): ≥ .91 to .94 across validation samples
• Tucker-Lewis Index (TLI): ≥ .90

Factor Loadings

All 38 anxiety items loaded significantly on their designated first-order factors, with standardized factor loadings predominantly ranging from .42 to .74 (p < .001). In turn, the first-order factors loaded robustly onto the higher-order general anxiety factor:

• Panic / Agoraphobia: Higher-order loading λ ≈ .85
• Generalized Anxiety: Higher-order loading λ ≈ .87
• Separation Anxiety: Higher-order loading λ ≈ .78
• Social Phobia: Higher-order loading λ ≈ .74
• Obsessive-Compulsive: Higher-order loading λ ≈ .68
• Physical Injury Fears: Higher-order loading λ ≈ .57

These findings provide empirical support for retaining both individual subscale scores and an overarching Total Anxiety score in clinical and research practice.

10. Instrument / Measurement Tool

• Instrument Name: Spence Children’s Anxiety Scale (SCAS)
• Target Population: Children aged 8 to 12 years (with parent-report, adolescent self-report, and preschool adaptations available)
• Administration Format: Self-report questionnaire, available in paper-and-pencil or computerized/digital administration
• Administration Time: Approximately 10 minutes
• Total Number of Items: 44 items
  • 38 specific anxiety symptom items (used in scoring)
  • 6 positive filler items (Items 11, 17, 25, 30, 37, 42; omitted from anxiety scoring)
  • 1 supplementary open-ended qualitative item (Item 44: optional phobic fear specification)
• Response Scale: 4-point Likert-type frequency scale:
  • 0 = Never
  • 1 = Sometimes
  • 2 = Often
  • 3 = Always
• Subscale Composition:
  • Separation Anxiety: Items 5, 8, 12, 15, 16, 43 (Score range: 0–18)
  • Social Phobia: Items 6, 7, 9, 10, 28, 34 (Score range: 0–18)
  • Obsessive-Compulsive: Items 14, 19, 26, 39, 40, 41 (Score range: 0–18)
  • Panic Disorder / Agoraphobia: Items 13, 21, 23, 24, 27, 29, 31, 33, 35 (Score range: 0–27)
  • Generalized Anxiety: Items 1, 3, 4, 20, 21b/22a, 36 (Score range: 0–18)
  • Physical Injury Fears: Items 2, 18, 22, 32, 38 (Score range: 0–15)
• Scoring and Interpretation Procedures:
  • Total Anxiety Score: Calculated by summing all 38 clinical items (theoretical range: 0 to 114). Higher scores indicate greater anxiety symptom burden.
  • Subscale Scores: Calculated by summing the scores of the items corresponding to each domain.
  • Standardization (T-Scores): Raw scores are converted to standardized T-scores based on age- and gender-stratified normative tables. A T-score of 50 represents the normative population mean (SD = 10).
  • Clinical Cutoffs:
    • T-score < 60: Normal range.
    • T-score 60–64: Elevated / Sub-clinical anxiety (1 to 1.5 SD above the normative mean), indicating vulnerability and a need for clinical monitoring.
    • T-score ≥ 65–70: Clinically significant range (1.5 to 2 SD above the mean), warranting comprehensive diagnostic evaluation via structured psychiatric clinical interview.

11. Permissions & Fee and Test Year

The Spence Children’s Anxiety Scale was originally published in 1997 (structural factor analysis) and 1998 (psychometric and clinical validation). Dr. Susan H. Spence has placed the SCAS in the public domain for academic, clinical, research, and non-commercial educational use. The instrument, scoring guidelines, normative tables, automated scoring engines, and cross-cultural translations are freely accessible via the official website (www.scaswebsite.com).

Licensing and Usage Terms:

• Fee: Free of charge. No licensing royalties are required for clinical practitioners, public schools, academic researchers, or healthcare systems utilizing the scale for non-commercial purposes.
• Commercial Use: Incorporation of the SCAS into commercial software, fee-for-service digital health platforms, or proprietary testing packages requires formal written permission and copyright clearance from the primary author.
• Modification: Users may not alter item wording, delete scale items, or change the response architecture without explicit authorization, as alterations compromise the validated psychometric properties of the instrument.

12. References

Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and reflective processing. Behaviour Research and Therapy, 35(1), 49–58. https://doi.org/10.1016/S0005-7967(96)00069-1

Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. Basic Books.

Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100(3), 316–336. https://doi.org/10.1037/0021-843X.100.3.316

Essau, C. A., Sakano, Y., Ishikawa, S., & Sasagawa, S. (2004). Meta-analysis of the Spence Children’s Anxiety Scale across cultures. Child Psychiatry and Human Development, 35(1), 45–63.

Ishikawa, S., Sato, H., & Sasagawa, S. (2009). Anxiety disorders in Japanese children and adolescents: Psychometric properties of the Spence Children’s Anxiety Scale. Journal of Anxiety Disorders, 23(7), 862–867. https://doi.org/10.1016/j.janxdis.2009.04.004

Mousavi, R., Moradi, A. R., Farzad, V., Mahdavi, E., & Spence, S. H. (2007). Psychometric properties of the Spence Children’s Anxiety Scale with an Iranian sample. International Journal of Psychology, 1(1), 1–16.

Muris, P., Schmidt, H., & Merckelbach, H. (2000). Correlations among two self-report questionnaires for measuring DSM-defined anxiety disorder symptoms in children: The Screen for Child Anxiety Related Emotional Disorders and the Spence Children’s Anxiety Scale. Personality and Individual Differences, 28(2), 333–346. https://doi.org/10.1016/S0191-8869(99)00102-6

Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. (2004). A parent-report measure of children’s anxiety: Psychometric properties and clinical utility of the Spence Children’s Anxiety Scale-Parent Version. Behaviour Research and Therapy, 42(7), 813–832. https://doi.org/10.1016/S0005-7967(03)00200-6

Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A revised measure of children’s manifest anxiety. Journal of Abnormal Child Psychology, 6(2), 271–280. https://doi.org/10.1007/BF00919131

Spence, S. H. (1997). Structure of anxiety symptoms among children: A confirmatory factor-analytic study. 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

Spence, S. H., Barrett, P. M., & Turner, C. M. (2003). Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. Journal of Anxiety Disorders, 17(6), 605–625. https://doi.org/10.1016/S0887-6185(02)00236-0

Spence, S. H., Rapee, R., McDonald, C., & Ingram, M. (2001). The structure of anxiety symptoms among preschoolers. Behaviour Research and Therapy, 39(11), 1293–1316. https://doi.org/10.1016/S0005-7967(00)00098-X

Spielberger, C. D. (1973). Preliminary manual for the State-Trait Anxiety Inventory for Children. Consulting Psychologists Press.

13. Items of the Scale (Questionnaire)