Beck, A. An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology , 56 6 , Lovibond, S. Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation. ISBN Hamilton, M. The assessment of anxiety states by rating. British Journal of Medical Psychology , 32 1 , Goodman, W. The Yale-Brown obsessive compulsive scale: I.
Development, use, and reliability. Archives of General Psychiatry , 46 11 , Early detection and treatment of anxiety disorders can reduce their adverse effects.
Early intervention is particularly important as these disorders often become apparent at critical stages of development in childhood, adolescence and early adulthood. The management plan developed for a young person with anxiety will be dependent upon a range of factors including:. The foundation for any helping relationship is establishing a therapeutic alliance, openly discussing the problem, and having a collaborative approach.
Other helpful strategies that can be introduced within this helping relationship include skill development around problem solving, stress management, activity planning, and psychoeducation.
A range of simple, guided self-help techniques for managing anxiety disorders has also been shown to be effective 1. Cognitive behavioural therapy is the most researched treatment for anxiety in young people, and CBT in various formats e.
Other psychological therapies including exposure-based, psychodynamic, narrative, supportive counselling, and eye movement desensitisation and reprocessing EMDR have also shown to be effective in reducing symptoms of anxiety and PTSD in children and adolescents 5. Medication treatments can be effective in reducing the core symptoms of anxiety disorders in children and adolescents most trials assessed the use of SSRIs a class of antidepressants in treating pediatric OCD 6.
However, their use in young people is cautioned given the concerns about increased risk of suicidal ideation and behaviour in children and adolescents using SSRIs 7. There is little evidence on the efficacy of other medications, including anti-anxiety drugs like benzodiazepines 6. Therefore, combined with the concerns of dependency issues with this class of drug, the routine use of benzodiazepines in young people cannot be recommended.
Cuijpers, P. Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine , 40 12 , Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews , Issue 2. DOI: Richardson, T. Computerised cognitive behavioural therapy for the prevention and treatment of depression and anxiety in children and adolescents: a systematic review.
Clinical Child and Family Psychology Review , 13 3 , Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents.
Cochrane Database of Systematic Reviews , Issue 4. Third, in the specific phobia—other type category, the clinical experts experienced some ambiguity with regard to all items. In both samples, youths received explicit instructions to call upon the research assistant non-clinical sample or the test diagnostician clinical sample in case they had any questions about the YAM-5 items. In the non-clinical sample, youths appeared to experience no difficulties while completing the new questionnaire: there were few questions about items and almost no missing values.
The clinical sample also included younger children and here there were slightly more questions, but on the whole children completed the scale without obvious problems. Only children with a specific learning disorder with impairment in reading needed assistance to complete the measure: in these cases, items were read aloud by the diagnostician while the child read along and rated the items.
While applying this procedure, children appeared to show good understanding of the items. These observations suggest that the scale is acceptable and suitable for measuring anxiety symptoms in youths aged 8 years or older. The only exception was the selective mutism subscale, which displayed alphas of 0. For various subscales, alpha values were in the moderate to sufficient range i. Table 4 presents the psychometric findings with regard to the parent version of the YAM-5, which was only completed for the clinically referred children and adolescents.
The internal consistency coefficients for the subscales appeared to be rather poor. The parent—child agreement appeared to be quite good, with correlations of 0. There was also support for the convergent and divergent validity of the YAM That is, a number of significant positive correlations were found with the Achenbach scales measuring internalizing problems, while no significant links were noted between the YAM-5 scores and externalizing.
Findings on the concurrent i. In order to get a first impression of the discriminant validity of new scale, analyses of variance were conducted to compare the YAMI and YAMII scores of the non-clinical adolescents, the clinically referred youths with anxiety disorders, and the clinically referred youths with other problems. As these three groups were not comparable in terms of age and gender, these variables were included in the analyses as covariates i.
However, as shown in Fig. This article describes the development of the YAM-5, a new scale for measuring anxiety disorder symptoms in children and adolescents according to the contemporary psychiatric classification system DSM Two international panels of experts, one consisting of childhood anxiety researchers and one of clinicians working with this type of psychopathology in daily practice, were used to develop, improve, and confirm the validity of items that were intended to measure the symptoms of the separate anxiety disorders as defined in the current edition of the DSM i.
A final questionnaire consisting of 50 items was constructed that is composed of two parts. The first part i. The second part i. With both parts combined, the YAM-5 assesses symptoms of the full spectrum of anxiety disorders that may occur in children and adolescents. The main issue here is differential diagnosis: it has been noted that even when only considering anxiety problems, it may still be quite hard to identify the correct anxiety disorder in relation to a given symptom [ 42 ].
Illustrative in this regard are the lack of a clear distinction between situational phobia and agoraphobia, and the problems experienced by our experts in discerning between selective mutism and social anxiety disorder, and among the different types of phobias. Another source of confusion originates from the fact that the central feature of one anxiety disorder can overlap and be present in other anxiety disorders.
Good examples are panic attacks, which are typical of panic disorder but also frequently occur in other anxiety disorders [ 43 ], and furthermore worry, which is most characteristic of generalized anxiety disorder but is also often present in other anxiety problems [ 44 ]. We addressed the attribution of symptoms to incorrect anxiety disorders by describing the symptoms more specifically and deleting items that were ambiguous and could not be reformulated in a more specific way.
Even though effort was made to design items for the YAM-5 that are as specific as possible to each anxiety disorder, it is clear that the problem of differential diagnosis cannot be completely resolved in this type of questionnaire. A critical point can be raised regarding the fact that in the YAM-5 agoraphobia is grouped with the specific phobias.
We have already clarified that the main reason for this was that on an item symptom level, it is not possible to differentiate agoraphobia from a situational specific phobia. In spite of this, there might also be good arguments for placing agoraphobia with the major anxiety disorders.
First, agoraphobia frequently co-occurs with panic disorder in adults [ 45 ], and this appears also true in children and adolescents [ 46 ]. Second, there are clear indications that catastrophic cognitions are quite elaborated in agoraphobia [ 47 ], and this feature shows more resemblance to the major anxiety disorders than to the specific phobias.
Third and finally, when looking at clinical presentation, agoraphobia is more severe and impairing than specific phobias [ 48 ], and, as such, more affiliated with the major anxiety disorders.
The children and adolescents who tested the YAM-5 did not report noteworthy difficulties with completing the scale. Internal consistency coefficients of the total anxiety disorders and phobias scales were good to excellent, whereas the reliability estimates for most subscales were in the acceptable to good range. There were a number of exceptions to this rule: for example, the internal consistency of the selective mutism scale was insufficient clinical sample and the same was also true for a number of phobia scales both samples.
In the case of selective mutism, the low alpha value may be due to the fact that this subscale taps a low-frequent anxiety problem by means of a limited set of items.
However, for animal phobia clinical sample and natural environment phobia non-clinical sample, the rather low reliability coefficients were less expected. Meanwhile, there is also research demonstrating that animal phobias are quite heterogeneous and consist of various dimensions [ 49 ], whereas natural environment phobias have not always emerged as a separate category but rather tend to blend with situational phobias [ 50 ].
It is good to keep in mind that phobias are by definition specific, and it may not be feasible to expect them to actually cluster with other phobias into the categories as described in the DSM. Data on the parent version of the YAM-5 were obtained in the clinical sample and yielded a number of interesting findings. First, reliability coefficients generally showed a similar pattern as those found for the child version.
These cross-informant figures compare favorably with those generally obtained in research on internalizing symptoms with an overall mean r of 0. Third and finally, on some YAM-5 sub scales parents displayed significantly lower sores than children. First evidence was also found for the validity of the new scale.
To begin with, YAM-5 scores correlated positively and significantly with the number of anxiety symptoms as reported by youths and parents during a structured clinical interview, which provides support for the concurrent validity. Further, indications were found for the convergent and divergent validity: that is, significant positive associations were noted with the internalizing scales of the Achenbach questionnaire, whereas no substantial links were observed with the externalizing scales of this measure.
Finally, clinically referred youths with anxiety disorders scored higher on the YAMI scale major anxiety disorders as compared to clinically referred youths with other problems and non-clinical controls, suggesting that the measure has discriminant validity.
The test of the validity of the YAM-5 was not optimal: the sample size of clinically referred children and adolescents was rather small and there were quite a number of youths with anxiety disorder not otherwise specified. Future investigations should be conducted in larger clinical samples with more variation in anxiety problems so that the discriminant validity can also be explored at a subscale level.
In addition, other aspects of reliability i. It is increasingly acknowledged that anxiety problems are situated on a continuum with low fear and anxiety at one end of a dimension, and high fear and anxiety or even phobias and anxiety disorders whereby there is significant interference with daily functioning at the other end [ 53 ].
As the YAM-5 is based on the content of fear and anxiety, which is the defining principle for the anxiety disorders as described in the DSM-5, one might have the impression that the scale is more or less a categorical measure. The present article describes the development of the YAM-5, a new questionnaire for assessing anxiety disorder symptoms in children and adolescents in terms of the contemporary classification system, the DSM International panels of childhood anxiety researchers and clinicians were consulted to construct a scale consisting of two parts: Part I i.
In general, the face validity of the new scale proved to be acceptable: most of its items were successfully linked to the intended anxiety disorders and phobias. A first test of the YAM-5 in two samples of non-clinical adolescents and clinically referred youths indicated that the measure was easy to complete. Further, support was found for the internal consistency reliability of the new measure as well as its parent—child agreement and concurrent, convergent, divergent, and discriminant validity.
In summary, the YAM-5 represents a potentially important addition to the assessment toolbox of clinicians and researchers who want to evaluate the level of anxiety disorder symptoms in children and adolescents. This DSM-based measure quantifies symptoms in a relatively brief, cost-effective, and reliable manner, and is particularly useful in situations where a diagnostic interview is not feasible.
However, more studies on the psychometric qualities of the scale and collection of normative data in both non-clinical and clinical populations of children and adolescents are urgently needed. The clinicians who conducted the final face validity check of the new scale are also kindly acknowledged. National Center for Biotechnology Information , U.
Child Psychiatry and Human Development. Child Psychiatry Hum Dev. Published online May Author information Copyright and License information Disclaimer. Peter Muris, Email: ln. Corresponding author. This article has been cited by other articles in PMC. Abstract The Youth Anxiety Measure for DSM-5 YAM-5 is a new self- and parent-report questionnaire to assess anxiety disorder symptoms in children and adolescents in terms of the contemporary classification system.
Introduction Anxiety disorders are among the most prevalent psychiatric problems in children and adolescents. Method Face Validity Checks An initial pool of 74 items was created, which was then sent by email to 50 research experts on childhood anxiety disorders. Suitability and Psychometric Properties of the YAM-5 To investigate the suitability and some psychometric properties of the YAM-5, data were collected in two separate samples. Results Initial Face Validity Check by Research Experts Table 1 presents the initial set of 74 items ordered in terms of the anxiety disorders they were intended to measure.
Open in a separate window. Separation Anxiety Disorder The majority of items measuring this type of anxiety were satisfactory in terms of sensitivity and specificity. Selective Mutism The items that were developed to measure selective mutism were reasonably sensitive given that, on average, Social Anxiety Disorder In general, the experts indicated that these items accurately reflected symptoms of this anxiety disorder.
Panic Disorder The sensitivity of most items referring to this anxiety disorder was good. Generalized Anxiety Disorder Almost all items that intended to assess this anxiety disorder showed good sensitivity and specificity. Specific Phobia: Animal Type All five items referring to this type of specific phobia displayed excellent sensitivity as well as specificity and thus were retained in the scale.
Specific Phobia: Natural Environment Type Two out of four items measuring this type of specific phobia appeared to have insufficient face validity. Specific Phobia: Blood—Injection—Injury Type Two out of three items were satisfactory in terms of sensitivity and specificity.
Specific Phobia: Other Type By definition, this is a residual category and, as such, it was hardly surprising that its face validity was limited. Construction of the Final Version of the Questionnaire As a result of this process, a total of 50 items was retained for the final questionnaire. Suitability In both samples, youths received explicit instructions to call upon the research assistant non-clinical sample or the test diagnostician clinical sample in case they had any questions about the YAM-5 items.
Parent—Child Agreement Table 4 presents the psychometric findings with regard to the parent version of the YAM-5, which was only completed for the clinically referred children and adolescents. Table 5 Findings on the concurrent i. Discussion This article describes the development of the YAM-5, a new scale for measuring anxiety disorder symptoms in children and adolescents according to the contemporary psychiatric classification system DSM Summary The present article describes the development of the YAM-5, a new questionnaire for assessing anxiety disorder symptoms in children and adolescents in terms of the contemporary classification system, the DSM References 1.
Prevalence and development of psychiatric disorders in childhood and adolescence. You seem to have a popup blocker enabled. If you want to skip this dialog please Always allow popup windows for the online course. National HIV Curriculum. Site Navigation. Long-Acting Injectable Regimens. Search for. Use this Search to quickly find items or navigate the site. Sign In or Register. Over the last 2 weeks , how often have you been bothered by the following problems?
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