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Behaviour Research and Therapy 43 (2005) 309322

www.elsevier.com/locate/brt

Psychometric properties of the Revised Child Anxiety and

Depression Scale in a clinical sample$
Bruce F. Chorpita, Catherine E. Moftt, Jennifer Gray
Department of Psychology, University of Hawaii at Manoa,
2430 Campus Road, Honolulu, HI 96822, USA
%
Received 1 October 2003; received in revised form 28 January 2004; accepted 16 February 2004

Abstract
This study examined the psychometric properties of the Revised Child Anxiety and Depression Scale
(RCADS) in a clinical sample of 513 youth referred for mental health assessment at a university clinic.
Internal consistency and factor analysis provided support for the factorial validity of the RCADS.
Convergent and discriminant validity tests against both clinical interview and self-report criteria also
suggested favorable properties of the RCADS. In comparative tests with traditional measures of anxiety
and depression, the RCADS generally showed greater correspondence to specic diagnostic syndromes.
Clinical cutoffs are reported for the purposes of future clinical and research applications.
r 2004 Elsevier Ltd. All rights reserved.
Keywords: Assessment; Anxiety; Children; Adolescents; Depression

1. Introduction
Given the high prevalence of anxiety disorders and depression among youth (Compas, 1997;
Kashani & Orvaschel, 1990), their measurement has long been a priority in both clinical and
$

Preparation of this article was supported in part by National Institute of Mental Health Grant R03 MH60134, an
award from the University of Hawaii Research Council, and awards from the Hawaii Departments of Health and
Education to the rst author.
Corresponding author.
E-mail address: chorpita@hawaii.edu (B.F. Chorpita).
0005-7967/$ - see front matter r 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.brat.2004.02.004

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research contexts. Accordingly, numerous instruments to measure these phenomena have been
developed (e.g., Spielberger state-trait anxiety inventory for children; Spielberger, 1973; Revised
Childrens Manifest Anxiety Scale, RCMAS; Reynolds & Richmond, 1978; fear survey schedule
for children-revised, Ollendick, 1983; childrens depression inventory (CDI; Kovacs, 1980).
Although these measures have demonstrated good psychometric properties, (Ollendick, 1983;
Reynolds, 1982; Reynolds & Paget, 1983; Saylor, Finch, Spirito, & Bennett, 1984), most are
appropriate for assessing constructs only indirectly related to dimensions of psychiatric disorders.
For example, several investigations have suggested that the RCMAS and CDI measure the
broader construct of negative affectivity rather than measuring anxiety and depression as separate
constructs, which could account for some observations of poor discriminant validity of these
measures (Lonigan, Carey, & Finch, 1994; Stark & Laurent, 2001). Only recently have measures
been explicitly designed to assess symptomatology associated with current diagnostic systems
(e.g., screen for child anxiety related emotional disorders Birmaher et al., 1997; Muris,
Merckelbach, Ollendick, King, & Bogie, 2002). Given that such research is beginning to produce
measures with improved clinical utility, continued research on measurement strategies in clinical
samples currently seems warranted (e.g., Chorpita, Yim, Moftt, Umemoto, & Francis, 2000a;
Muris et al., 2002; Stark & Laurent, 2001).
The Revised Child Anxiety and Depression Scale (RCADS; Chorpita et al., 2000a) is one such
measure designed to assess for clinical syndromes in youth. The RCADS is a revision of the
Spence Childrens Anxiety Scale (SCAS; Spence, 1997, 1998), adapted to correspond more closely
to selected DSM-IV anxiety disorders (i.e., separation anxiety disorder, social phobia, generalized
anxiety disorder, obsessivecompulsive disorder, panic disorder) and includes a scale for major
depression. At present, three normative studies have examined the clinical utility and
psychometric properties of the RCADS among community samples of school children (Chorpita
et al., 2000a; de Ross, Gullone, & Chorpita, 2002). Given the positive ndings from those
investigations, the current study sought to further the investigation of the psychometric properties
of the RCADS in a clinically referred sample of children and adolescents.

2. Method
2.1. Participants
Participants were 513 children and adolescents consecutively referred for assessment to the
University of Hawaii Center for Cognitive Behavior Therapy. The majority of referrals came from
public school professionals and parents. Parental marital status in these families was as follows:
married, 45.6%; divorced 23.2%; single parent 15.6%; separated 9.4%; widowed, 3.1% (data
were not reported for 3.1% of cases). Modal education level for parents was a high school
diploma or equivalent. Median household income was $40,000 (SD=$34,169; data not reported
for 32.9% of cases).
Grade level ranged from 3 to 12, the mean age was 12.9 years (SD=2.7; range=7.517.9), and
the group consisted of 167 girls (32.6%) and 346 boys (67.4%). Major ethnicities reported were
Caucasian (n 82; 16.0%), Hawaiian (n 53; 10.3%), Japanese American (n 49; 9.6%),
Filipino (n 27; 5.3%), and Multiethnic (n 222; 43.3%). The remaining participants (n 80;

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311

Table 1
Principal and co-principal diagnoses
Diagnosis

Principal diagnosis
Frequency

None
Separation anxiety disorder
Social phobia
Specic phobia
Obsessivecompulsive disorder
Panic disorder with agoraphobia
Agoraphobia without panic disorder
Generalized anxiety disorder
PTSD
Anxiety disorder NOS
Major depressive disorder
Dysthymic disorder
Bipolar disorder
Depressive disorder NOS
Adjustment disorder
ADHD
Oppositional deant disorder
Conduct disorder
Disruptive behavior disorder NOS
Other
Total

Co-principal diagnosis
Percent

Frequency

Percent

84
14
38
2
14
6
2
10
13
8
22
8
0
2
18
97
67
43
19
46

16.4
2.7
7.4
0.4
2.7
1.2
0.4
1.9
2.5
1.6
4.3
1.6
0.0
0.4
3.5
18.9
13.1
8.4
3.7
9.0

455
3
8
2
0
0
0
4
0
0
3
1
1
0
1
17
10
1
1
6

88.7
0.6
1.6
0.4
0.0
0.0
0.0
0.8
0.0
0.0
0.6
0.2
0.2
0.0
0.2
3.3
1.9
0.2
0.2
1.2

513

100.0

513

100.0

Note. PTSD=post-traumatic stress disorder; NOS=not otherwise specied; ADHD=attention-decit/hyperactivity

disorder; other includes substance abuse, substance dependence, Aspergers disorder, pervasive developmental disorder,
not otherwise specied, Tourettes Disorder, Enuresis, selective mutism, trichotillomania, Body dysmorphic disorder,
Anorexia nervosa, parentchild relational problem, and sibling relational problem. Co-principal diagnosis refers to a
comorbid disorder determined to be of equal severity to the principal diagnosis.

15.6%) identied principally with one of the following: Chinese, Korean, African American,
Hispanic American, or Samoan. All children spoke English in school. Information about the
principal diagnoses of participants appears in Table 1.
2.2. Measures
2.2.1. Anxiety disorders interview schedule for DSM-IV, child and parent versions (ADIS-IV-C/P;
Silverman & Albano, 1996)
The ADIS-IV-C/P is a semi-structured clinical interview for parents and children aged 717
that is specically designed for detailed DSM-IV diagnosis of childhood anxiety and mood
disorders and that allows for the diagnosis of disruptive behavior disorders, disorders of attention,
and other disorders of childhood. Separate diagnostic proles are derived from a parent and a
child interview, which are combined to form a consensus diagnosis (Silverman & Albano, 1996).

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Good to excellent interrater reliability has been demonstrated for the ADIS-IV-C/P (Silverman,
Saavedra, & Pina, 2001).
2.2.2. Dimensional ratings (Chorpita, Plummer, & Moffitt, 2000b)
Following each diagnostic interview, ADIS-IV-C/P interviewers completed a separate measure
that required them to assign severity ratings for 13 DSM-IV disorders, whether or not criteria
were met for those disorders. Ratings were based on clinicians assessments of the degree to which
the dimension of each disorder was present in the child. Ratings were completed separately for
parent and child interviews. These scores ranged from 0 to 8, with higher scores representing
increased clinical severity. Thus, a child with severe panic disorder might get a rating of 7 or 8 for
that disorder, whereas a child with mild apprehension about shortness of breath might receive a
rating of 2 or 3.
2.2.3. Childrens depression inventory (CDI; Kovacs, 1980/1981)
The CDI is a 27-item self-report measure designed to assess cognitive, behavioral, and affective
symptoms of depression. Each item consists of three statements of different severity (scored 02)
and requires the child to choose one statement that best describes him or her. Scores range from 0
to 54, with higher scores indicating more depressive symptoms. The CDI is the most widely used
measure of depression in children, with good support for its reliability and validity (e.g., Saylor
et al., 1984).
2.2.4. Revised Child Anxiety and Depression Scales (RCADS; Chorpita et al., 2000a)
The RCADS is a 47-item self-report questionnaire, with scales corresponding to separation
anxiety disorder (SAD), social phobia (SP), generalized anxiety disorder (GAD), panic disorder
(PD), obsessive compulsive disorder (OCD), and major depressive disorder (MDD). The RCADS
requires respondents to rate how often each item applies to them. Items are scored 03
corresponding to never, sometimes, often, and always. Several investigations have
demonstrated support for the RCADS in non-referred samples of youth (Chorpita et al., 2000a;
de Ross et al., 2003).
2.2.5. Revised Childrens Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978)
The RCMAS is as 37-item self-report measure designed to assess the symptoms of anxiety. The
items are dichotomous (i.e., yes/no), and scores range from 0 to 28, with higher scores
representing greater anxiety. The instrument is one of the most widely used instruments for
assessing childhood anxiety, and has been demonstrated to be reliable across different gender,
racial, and age groups (Reynolds & Paget, 1983).
2.3. Procedure
At the time of the initial visit, child and parent read and signed consent forms describing the
study procedures. The child participated in the structured diagnostic interview, and then lled out
questionnaires while interviewers administered the ADIS-IV to parent(s). Undergraduate
volunteers provided assistance if children had difculty reading.

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3. Results
3.1. Internal consistency
The RCADS scales were found to have good internal consistency in this sample (aSAD :78;
aSOC :87; aOCD :82; aPD :88; aGAD :84; aMDD :87).
3.2. Confirmatory factor analysis
Conrmatory factor analysis was performed to determine the t of the factor structure
identied in previous research with the RCADS. Fit indices included the Goodness of Fit Index
(GFI; Joreskog & Sorbom, 1993), the Comparative Fit Index (CFI; Bentler, 1990), the Root
Mean Square Error of Approximation (RMSEA; Steiger, 1990), and the standardized Root Mean
Square Residual (RMR). For the GFI and the CFI, scores of .90 and above conventionally
represent good model t. Browne and Cudek (1993) suggest that RMSEA values below .08
represent acceptable t, and that values at or below .05 represent good t. Lower values of the
RMR reect better t, with values of .05 or lower representing excellent t.
The 47 items were subject to CFA across all 513 participants. The resulting t statistics appear
in Table 2 and represent adequate model t. All factor loadings were statistically signicant
(po:05). Loadings ranged from .52 to .69 (Separation Anxiety factor), .51 to .78 (Social Anxiety
factor), .55 to .74 (obsessivecompulsive factor), .55 to .76 (Panic factor), .59 to .79 (Generalized
Anxiety factor), .53 to .70 (Depression factor). The maximum modication index in the Lx (factor
loading) matrix was 45.26, corresponding to the path from the depression latent factor to the item
trouble going to school. The expected change associated with this xed path indicated that its
estimation would result in a loading of .61 on the depression factor. The next highest modication
index in the Lx matrix again involved the item trouble going to school. The modication index
for this item on the social anxiety factor was 33.95. The completely standardized expected change
associated with this xed path indicated that its estimation would result in a factor loading of .39.
No other modication indices were pronounced enough to suggest any further problems with
item-factor relations.

Table 2
Fit statistics for the conrmatory factor analytic models
Difference from 6 factor
Model

w2

df

GFI

RMSEA

CFit

SRMR

CFI

AIC

w2

df

6 Factors
2 Factors
1 Factor

2844.74
3175.84
3187.98

1019
1033
1034

0.0
0.0
0.0

0.80
0.78
0.78

0.06
0.07
0.07

0.00
0.00
0.00

0.05
0.39
0.53

0.97
0.97
0.97

3234.60
3455.79
3455.83

331.10
343.24

14
15

Note. GFI=goodness-of-t index; RMSEA=root mean square error of approximation; CFit=test for close t
(RMSEAo.05); SRMR=standardized root mean square residual; CFI=comparative t index; AIC=Akaikes
information criterion.

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The original six-factor solution was tested against an alternative single factor model, as well as a
two-factor model (anxiety, depression), collapsing the 5 anxiety scales into a single factor. The t
statistics for these competing models appear in Table 2 and represent signicantly degraded model
t: w2diff 15 331:10 po:001, (1 factor versus 6 factor); w2diff 14 343:24, po:001, (2 factor
versus 6 factor), which showed support for the hypothesized model.
3.3. Group differences
All participants were evaluated for differences across grade level and gender. As with the
original normative investigation of the RCADS, grade levels were collapsed in pairs to create 5
groups (3rd and 4th, 5th and 6th, etc.). Means and standard deviations appear in Table 3. A 2  5
(gender  grade) MANOVA was performed, using each of the six RCADS scales as the dependent
variables. According to the observed value of Pillais Trace, both grade [F 6; 1936 5:05,
po:001] and gender [F 6; 481 4:868, po:001] showed signicant main effects on the set of
dependent variables. Their interaction was not signicant [F6; 1936 1:13, p :303]. The
results reected a modest association between both grade and gender and the combined six
RCADS scales, partial Z2 :06 for both.
To investigate the impact of grade and gender on the individual RCADS scales, univariate
ANOVAs were performed on each of the six scales. Results revealed a signicant main effect of
gender on the GAD [F 1; 486 17:93, po:001], PD [F 1; 486 5:88, p :016] and SOC
[F 1; 486 8:34, p :004] scales. In each case, girls scored higher than boys. The results reected
only a modest association, however, between gender and scores on these scales, partial Z2 :04,
.01, and .02, respectively.
Results of follow-up univariate tests also revealed a signicant effect of grade on the SAD
[F 4; 486 9:81, po:01] and OCD [F 4; 486 2:58, p :04] scales. The effect size for grade
Table 3
RCADS subscale raw means and standard deviations by grade level and gender
MDD

SAD

SOC

GAD

OCD

PD

Grade

SD

SD

SD

SD

SD

SD

Girls
34
56
78
910
1112

6.80
6.66
8.04
9.38
9.81

4.76
5.34
6.26
6.56
6.05

5.82
4.24
2.96
3.46
3.93

4.24
3.80
2.86
3.79
3.55

7.48
9.09
9.61
9.90
10.61

4.90
5.63
4.97
6.81
4.84

6.50
5.85
5.32
6.46
7.63

3.70
3.89
3.19
4.52
4.73

4.95
4.19
3.25
3.69
4.33

3.92
4.21
3.79
4.12
4.18

5.33
4.55
4.61
5.52
5.75

4.83
5.15
4.76
5.39
5.62

Boys
34
56
78
910
1112

7.16
7.72
6.34
7.25
6.68

4.69
6.00
5.46
5.94
4.53

6.12
4.00
2.74
2.82
1.83

4.71
4.32
3.47
3.09
2.43

7.63
8.70
6.97
8.17
6.70

5.71
6.70
4.82
5.94
4.88

5.16
5.27
4.20
5.00
3.58

3.85
4.56
3.56
3.76
2.88

4.32
4.78
3.00
3.31
2.96

3.40
4.29
3.62
3.39
3.51

4.56
5.30
3.59
3.60
2.73

4.30
6.07
4.71
3.69
2.67

Note. SAD=separation anxiety disorder; SOC=social phobia; OCD=obsessivecompulsive disorder; PD=panic

disorder; GAD=generalized anxiety disorder; MDD=major depressive disorder.

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group was small, partial Z2 :08 and .02, respectively. Post-hoc analyses with Tukeys HSD
revealed that, for the SAD scale, the group comprised of third and fourth graders scored
signicantly higher than each of the four other groups (po:01), which did not differ signicantly
from one another. For the OCD scale, post-hoc analyses showed that the fth and sixth grade
group scored signicantly higher on the OCD scale than the seventh and eighth grade group
(po:05). No other grade groups were signicantly different from one another.
3.4. Correlations with dimensional ratings and with other self-report measures
In order to examine the convergent and discriminant validity of the RCADS in a clinical
sample, correlations of the RCADS scales with interview dimensional ratings and with the
RCMAS and CDI were evaluated. Table 4 shows the convergent validity coefcients of the
RCADS scales as well as for the CDI and RCMAS on selected criteria. The RCADS scales
correlated positively and signicantly with all convergent child and parent interview ratings for
their target syndromes (columns 1 and 2, top of table). The RCADS was also expected to correlate
with other self-report measures of anxiety and depression, and column 3 shows that the RCADS
MDD scale correlated positively and signicantly with the CDI, and the RCADS anxiety scales
each correlated positively and signicantly with the RCMAS. For comparison purposes, the CDI
and RCMAS were also correlated with parent and child interview ratings (columns 1 and 2,
bottom of table). These correlations were signicant for the CDI, and variably signicant for the
Table 4
Correlations of RCADS, CDI and RCMAS with convergent validity criteria
Scale

Dimensional ratings
Construct

RCADS
MDD
OCD
GAD
SAD
PD
SOC

Depression
Obsessivecompulsive
Generalized anxiety
Separation anxiety
Panic
Social phobia

CDI

Depression

RCMAS
RCMAS
RCMAS
RCMAS
RCMAS

Obsessivecompulsive
Generalized anxiety
Separation anxiety
Panic
Social phobia

Self report
Parent

Child

Scale

.45*
.22*
.26*
.29*
.31*
.24*

.65*
.34*
.48*
.52*
.42*
.54*

CDI
RCMAS
RCMAS
RCMAS
RCMAS
RCMAS

.43*

.62*

.01
.12
.06
.16
.04

.70*
.59*
.65*
.60*
.64*
.72*

.17
.46*
.32*
.33*
.44*

Note. RCADS=Revised Child Anxiety and Depression Scale; MDD=major depressive disorder; OCD=obsessivecompulsive disorder; GAD=generalized anxiety disorder; SAD=separation anxiety disorder; PD=panic disorder;
SOC=social phobia; DEP-C=dimensional ratings of depression based on child report; DEP-P=dimensional ratings
of depression based on parent report; CDI=child depression inventory; RCMAS anxiety=Revised Childrens
Manifest Anxiety Scale, Total Anxiety Scale.
*po:01.

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RCMAS, but uniformly lower for all convergent validity coefcients than those demonstrated by
the RCADS.
To test the discriminant validity of the RCADS, the scales were correlated with child and
parent interview ratings of oppositional behavior problems. Table 5 shows that all correlations
were non-signicant and near zero. For comparative purposes, the CDI and RCMAS were also
correlated with these discriminant criteria, and it was observed that the CDI correlated positively
and signicantly with parent and child interview ratings of oppositional behavior.
RCADS scales were also tested relative to self-report measures of non-target constructs. Table 6
shows the correlation of the RCADS MDD scale with the RCMAS and the correlations of the
RCADS 5 anxiety scales with the CDI. These ndings were uniformly positive and signicant,
although lower than the convergent coefcients with the target measures (anxiety-anxiety
correlations and depression-depression correlation from Table 4). One exception was that the
RCADS MDD scale correlated more highly with the RCMAS (r :72) than with the CDI
(r :70).
Given previous ndings that the CDI and RCMAS have been found to correspond to general
feelings of negative affectivity (Chorpita, Albano and Barlow, 1998; Lonigan et al., 1994), these
analyses were repeated by residualizing the discriminant criterion to remove unwanted variance
prior to calculating the correlations. For example, CDI scores were regressed on RCMAS, and the
residuals were retained to represent an anxiety free depression score, which could then be
correlated with the RCADS MDD scale. Likewise, RCMAS scores were residualized using CDI
scores to create depression free anxiety scores, which were then correlated with the RCADS
anxiety scales. These results appear in column 2 of Table 6 and were nonsignicant, with the
exception of the discriminant coefcients for RCADS MDD and RCADS PD.

Table 5
Correlations of RCADS, RCMAS and CDI with discriminant validity criterion
Scale

Dimensional ratings
Construct

Parent

Child

.07
.04
.01
.02
.05
.05

.09
.05
.01
.01
.05
.06

RCADS
MDD
OCD
GAD
SAD
PD
SOC

Oppositional
Oppositional
Oppositional
Oppositional
Oppositional
Oppositional

CDI

Oppositional behavior

.17*

.15*

RCMAS

Oppositional behavior

.06

.05

behavior
behavior
behavior
behavior
behavior
behavior

Note. RCADS=Revised Child Anxiety and Depression Scale; MDD=major depressive disorder; OCD=obsessivecompulsive disorder; GAD=generalized anxiety disorder; SAD=separation anxiety disorder; PD=panic disorder;
SOC=social phobia; CDI=child depression inventory; RCMAS=Revised Childrens Manifest Anxiety Scale, Total
Anxiety Scale.
*po:01.

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Table 6
Correlations of RCADS scales with discriminant validity self-report criteria
Scale

Discriminant scale

r with residualized criterion

RCADS
MDD
OCD
GAD
SAD
PD
SOC

RCMAS
CDI
CDI
CDI
CDI
CDI

.72*
.49*
.53*
.47*
.59*
.56*

.36*
.12
.05
.06
.20*
.14

Note. RCADS=Revised Child Anxiety and Depression Scale; MDD=major depressive disorder; OCD=obsessivecompulsive disorder; GAD=generalized anxiety disorder; SAD=separation anxiety disorder; PD=panic disorder;
SOC=social phobia; CDI=child depression inventory; RCMAS=Revised Childrens Manifest Anxiety Scale, Total
Anxiety Scale.
*po:01.

3.5. Analysis of diagnostic groups

Between-groups analyses were conducted to examine the utility of the RCADS for
differentiating among those receiving diagnoses corresponding to the dimensions measured on
a given RCADS scale and those not receiving such diagnoses. All of these analyses showed that
the RCADS signicantly discriminated between the target and non-target groups (see Table 7).
For comparison, the CDI and RCMAS were evaluated in a similar manner. The RCMAS
discriminated between anxiety disorders and controls, but with a considerably smaller effect size
than for the same test with the RCADS Total Anxiety Scale. CDI scores differed signicantly
between depressed and non-depressed, also with a somewhat smaller effect size than for the same
test with the RCADS MDD Scale. Because the RCMAS was not designed to identify individual
diagnostic groups, these tests were omitted from the table (average effect size for these
discriminations was Z2 :01).
3.6. Receiver operator characteristic (ROC) analyses
To identify cutoff scores of the various RCADS scales, the sensitivity, or probability that a child
diagnosed with a disorder would be identied by the instrument as exhibiting symptoms of that
disorder, and the specificity, or the probably that an individual without a diagnosis would be
identied by the instrument as not evidencing symptoms of that disorder, were plotted for each
scale for each item cutoff (see Fig. 1). Diagnostic tools typically strive to optimally balance both
sensitivity and specicity. ROC analysis can identify cutoff points for scales that can maximize the
total number of true positive and true negative cases.
For the MDD scale, a score of 11 appeared to optimize sensitivity and specicity, yielding a
sensitivity of .74 and a specicity of .77 for the prediction of major depressive disorder. For the
SOC scale, a score of 10 yielded sensitivity of .59 and specicity of .64 for the prediction of social
phobia. For the GAD scale, a score of 7 yielded a sensitivity of .69 and a specicity of .72 for the
prediction of generalized anxiety disorder. For the SAD scale, a score of 5 yielded a sensitivity

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Table 7
One-way ANOVA and normative T scores for differentiation among target groups
T

Z2

5.22
5.41

68.78
48.20

40
462

87.31

.00

.149

21.36
10.80

7.47
7.94

57.08
51.80

37
401

60.40

.00

.122

Any Anxiety
No Anxiety

33.02
21.59

19.06
17.79

50.75
42.93

187
326

46.58

.00

.084

RCMAS

Any Anxiety
No anxiety

11.72
9.20

6.87
6.82

42.05
39.26

69
112

5.80

.017

.031

RCADS OCD

OCD
No OCD

7.38
3.77

4.27
3.79

56.12
44.62

23
484

19.72

.00

.038

RCADS GAD

GAD
No GAD

8.50
5.05

4.79
3.84

53.75
44.02

35
477

25.48

.00

.048

RCADS SAD

SAD
No SAD

7.86
3.56

3.90
3.82

62.44
51.05

30
479

35.61

.00

.066

RCADS PD

PD
No PD

14.11
4.33

4.68
4.72

77.54
49.80

9
500

38.02

.00

.070

RCADS SOC

SOC
No SOC

11.72
7.63

5.49
5.62

50.77
42.51

88
421

39.98

.00

.079

Scale

Target group /non-target group

RCADS MDD

MDD
No MDD

6.82
14.89

CDI

MDD
No MDD

RCADS Anx

SD

Note: Anx=total anxiety score; SAD=separation anxiety disorder, SOC=social anxiety, OCD=obsessivecompulsive
disorder, PD=panic disorder, GAD=generalized anxiety disorder, MDD=major depressive disorder, RCADS=Revised Child Anxiety and Depression Scale, CDI=Childrens Depression Inventory, RCMAS=Revised Childrens
Manifest Anxiety Scale, total anxiety score.

of .73 and a specicity of .69 for the prediction of separation anxiety disorder. For the OCD scale,
a score of 5 yielded a sensitivity of .70 and a specicity of .65 for the prediction of
obsessivecompulsive disorder. Finally, for the PD scale, a score of 12 yielded a sensitivity of .78
and a specicity of .92 for the prediction of panic disorder. ROC curves for the MDD scale and
PD scale showed the most favorable prediction above chance (see Fig. 1).

4. Discussion
The results are consistent with the developing literature in this area suggesting that recently
developed multidimensional measures of childhood anxiety and negative emotions show
promising clinical utility relative to traditional trait measures (e.g., Muris et al., 2002). In the
present study, the RCADS showed favorable convergent, discriminant, and factorial validity.
Despite these broadly supportive ndings, some specic results emerged that warrant further
review. For example, the factor analysis suggested that the item trouble going to school showed
an equal association with the depression scale in this sample as with the separation anxiety scale
with which the item factored in previous research. This observation suggests several possibilities,

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SOC

MDD

1.00

1.00

0.75

Specificity

0.75

0.50

0.50

0.25

0.25

0.00
0.00

0.25

0.50

0.75

1.00

0.00
0.00

0.25

0.50

Specificity

GAD
1.00

0.75

0.75

0.50

0.50

0.25

0.25

0.25

0.50

0.75

1.00

0.00
0.00

0.25

OCD

0.50

0.75

1.00

1.00

0.75

Specificity

1.00

Panic

1.00

0.75

0.50

0.50

0.25

0.00
0.00

0.75

SAD

1.00

0.00
0.00

319

0.25

0.25

0.50

Sensitivity

0.75

1.00

0.00
0.00

0.25

0.50

0.75

1.00

Sensitivity

Fig. 1. Receiver operator characteristic curves for the six subscales of the RCADS relative to DSM-IV diagnoses. Note: MDD=major
depressive disorder, SOC=social phobia, GAD=generalized anxiety disorder, SAD=separation anxiety disorder, OCD=obsessivecompulsive disorder, and PD=panic disorder.

including (a) that the item might be better assigned to the depression scale, (b) that the item might
be altogether unsuitable, given its lack of specicity, or (c) that the item might perform differently
in different populations. This last possibility is consistent with the data, given that participants

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demonstrated nearly three times the prevalence of depression relative to separation anxiety
(see Table 1). Nevertheless, the suitability of this item should be investigated further in future
studies.
The correlations of the RCADS scales with other self-report measures were also somewhat
difcult to interpret. For example, in Table 6, the RCADS MDD scale correlated rather highly
with the RCMAS total anxiety score (r :72). This raises the issue of the lack of convergent
criteria using self-report when conducting this type of research; i.e., the convergent criteria may be
less perfect measures of the target construct than the experimental measure, thereby obfuscating
the interpretation of validity coefcients. For example, the RCMAS, designed to measure anxiety
generally, correlated with the CDI at .67 in this sample and with interview clinical ratings of
depression at .48, suggesting that the RCMAS contains considerable variance unrelated to anxiety
(cf. Lonigan et al., 1992; Muris et al., 2002). Residualizing the self-report measures to remove
non-target variance appeared to correct most of these problems (Table 6, column 2), but the
correlation of the RCADS MDD scale with residualized RCMAS scores remained high. As such,
future research involving validity analyses with other self-report measures should select from the
newer, syndrome specic measures available (e.g., SCARED; Birmaher et al., 1997), which might
lead to more interpretable tests.
The traditional measures of anxiety and depression used here for comparison showed rather
different strengths and weaknesses that are noteworthy. Specically, the RCMAS appeared to
have reasonable discriminant validity for a construct related to externalizing problems, whereas
the CDI did not (see Table 5). Relative to the RCADS, this observation suggests that a trait
measure of depression such as the CDI is more likely to capture variance related to negative
emotions characteristic of youth with disruptive behavior (e.g., anger, annoyance) than is a
symptom-specic measure such as the RCADS. Thus, the RCADS appears to be better suited for
discriminations in mixed clinical sample.
A reverse pattern was found in terms of convergent validity of the CDI and RCMAS in the
comparative tests. That is, the CDI demonstrated reasonable convergent validity for depression,
but the RCMAS showed poor convergent validity with anxiety dimensions. This is likely due to
the design of the RCMAS to assess anxiety as a broader construct, rather than as specic clinical
dimensions. Even in the test to identify the presence or absence of anxiety disorders in general, the
RCMAS fared comparatively poorly, with an effect size nearly a third smaller than that of the
RCADS, suggesting that the latter measure is better suited in this context to identify both specic
anxiety disorders as well as the presence of any anxiety disorder.
Although the RCADS showed uniformly higher effect sizes than traditional measures in the
tests comparing diagnostic target groups with controls, all of the observed effect sizes were rather
low, particularly for anxiety disorders. This may be due in part to the limited power associated
with convergence tests relative to dichotomous criteria (e.g., diagnosis), as is consistent with the
higher validity coefcients observed with the interview DRs. Also, the highly differentiated
nosology for anxiety disorders allows for high base rates of non-target anxiety disorders among
the control groups in such tests. For example, comparing youth with and without social anxiety
allows for as many as 8 other possible anxiety diagnoses that could be assigned to youth in the
control group (i.e., any anxiety disorder other than social anxiety). The fact that the same
possibility for comorbidity can rarely occur for depression may account for the higher effect sizes
noted for tests using depression diagnosis as a convergent criterion.

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321

In general, these diagnostic analyses could be made more powerful by removing those youth
from the control group with disorders related to the target disorder (e.g., comparing youth with
social anxiety only to youth with no anxiety disorders). However, these tests were not performed
in this investigation due to their lack of apparent applied value, as such discriminations would
never be attempted in practice. Nevertheless, despite some of the limitations of these tests, the
subsequent ROC analyses pointed to relatively favorable psychometrics for identifying target
diagnoses.
Overall, the properties of the RCADS appear to be favorable in a clinical sample, such that its
use for clinical purposes appears justied. Comparative analyses with traditional measures of
anxiety and depression suggest that these other measures may be preferable for different
conditions of use, for example in screening for trait dimensions or personality features, whereas
the RCADS is keyed more closely to specic clinical syndromes. Future examination of the
RCADS with mainland US samples is recommended, as it would provide a useful comparison
with the extant data from Australia and Hawaii.

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