Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Comparing Parent and Child Self-report Measures of the State-Trait Anxiety Inventory in Children and Adolescents with a Chronic Health Condition

  • 130 Accesses

Abstract

Anxiety symptoms in children and adolescents with a chronic health condition have been estimated as high as 40% lifetime prevalence. Clinicians often rely on parent/caregiver information to supplement or substitute child self-report related to pediatric physical and mental health. We developed a caregiver proxy version (STAI-P) for the State-Trait Anxiety Inventory (STAI) State Anxiety Scale that was compared with a child self-report version in 201 parent–child dyads to evaluate its utility in measuring state anxiety in chronically ill youth. For patients aged 7–12, self-reports of state anxiety were moderately associated with parent distress and health provider-reported functional status, but negatively associated with parent STAI-P scores. For patients aged 13–17, self-reports of state anxiety were significantly associated with STAI-P scores, parent distress, and health provider-reported functional status. The STAI-P parent version may be a useful tool in identifying and addressing anxiety symptoms in youth living with a chronic health condition.

This is a preview of subscription content, log in to check access.

References

  1. Abate, C., Lippé, S., Bertout, L., Drouin, S., Krajinovic, M., Rondeau, É., … Sultan, S. (2018). Could we use parent report as a valid proxy of child report on anxiety, depression, and distress? A systematic investigation of father-mother-child triads in children successfully treated for leukemia. Pediatric Blood & Cancer,65(2), e26840.

  2. Barton, B., & North, K. (2004). Social skills of children with neurofibromatosis type 1. Developmental Medicine and Child Neurology,46, 553–563.

  3. Becker-Haimes, E. M., Jensen-Doss, A., Birmaher, B., Kendall, P. C., & Ginsburg, G. S. (2018). Parent-youth informant disagreement: Implications for youth anxiety treatment. Clinical Child Psychology and Psychiatry,23(1), 42–56.

  4. Beesdo, K., Dipl-Psych, S. K., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. Psychiatric Clinics of North America,32(3), 483–524.

  5. Berg-Nielsen, T. S., Vika, A., & Dahl, A. A. (2003). When adolescents disagree with their mothers: CBCL-YSR discrepancies related to maternal depression and adolescent self-esteem. Child: Care, Health Development,29(3), 207–213.

  6. Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry,36(4), 545–553.

  7. Briggs-Gown, M. J., Carter, A. S., & Schwab-Stone, M. (1996). Discrepancies among mother, child, and teacher reports: Examining the contributions of maternal depression and anxiety. Journal of Abnormal Child Psychology,24(6), 749–765.

  8. Burstein, M., Beesdo-Baum, K., He, J. P., & Merikangas, K. R. (2014). Threshold and subthreshold generalized anxiety disorder among US adolescents: prevalence, sociodemographic, and clinical characteristics. Psychological Medicine,44(11), 2351–2362.

  9. Bussing, R., Burket, R. C., & Kelleher, E. T. (1996). Prevalence of anxiety disorders in a clinical-based sample of pediatric asthma patients. Psychosomatics,37(2), 108–115.

  10. Canning, E. H., Hanser, S. B., Shade, K. A., & Boyce, W. T. (1992). Mental disorders in chronically ill children: parent-child discrepancy and physician identification. Pediatrics,90, 692–696.

  11. Caplan, R., Siddarth, P., Gurbani, S., Hanson, R., Sankar, R., & Shields, W. D. (2005). Depression and anxiety disorders in pediatric epilepsy. Eplilepsia,46(5), 720–730.

  12. Chandawani, K. D., Zhao, F., Morrow, G. R., Deshields, T. L., Minasian, L. M., Manola, J., & Fisch, M. J. (2017). Lack of patient-clinician concordance in cancer patients: Its relation with patient variables. Journal of Pain and Symptom Management,53(6), 988–998.

  13. 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.

  14. De Los Reyes, A., & Kazdin, A. E. (2011). Informant discrepancies in assessing child dysfunction relate to dysfunction within mother-child interactions. Journal of Child and Family Studies,15(5), 643–661.

  15. Denham, S. A. (1998). Emotional development in young children. New York: Guilford.

  16. Derogatis, L. R., & Fitzpatrick, M. (2004). The SCL-90-R, the brief symptom inventory (BSI) and the BSI-18. In M. E. Maurish (Ed.), The use of psychological testing for treatment planning and outcome assessment (pp. 1–41). Mahwah, NJ: Lawrence Erlbaum Associates.

  17. Edelbrock, C., Costello, A. J., Dulcan, M. K., Conover, N. C., & Kala, R. (1986). Parent-child agreement on child psychiatric symptoms assessed via structured interview. Journal of Child Psychology and Psychiatry,27(2), 181–190.

  18. Ersig, A. L., Kleiber, C., McCarthy, A. M., & Hanrahan, K. (2013). Validation of a clinically useful measure of children’s state anxiety before medical procedures. Journal for Specialists in Pediatric Nursing,18(4), 311–319.

  19. Ettinger, A. B., Weisbrot, D. M., Nolan, E. E., Gadow, K. D., Vitale, S. A., Andriola, M. R., … Hermann, B. P. (1998). Symptoms of depression and anxiety in pediatric epilepsy patients. Epilepsia,39(6), 595–599.

  20. Graf, A., Landolt, M. A., Mori, A. C., & Boltshauser, E. (2006). Quality of life and psychological adjustment in children and adolescents with neurofibromatosis type 1. Journal of Pediatrics,149, 348–353.

  21. Hamblin, R. J., Salloum, A., Andel, R., Nadeau, J. M., McBride, N. M., Lewin, A. B., & Storch, E. A. (2016). Predictors of parent-child agreement on child anxiety diagnoses on the ADIS-IV-C/P. Psychiatry Research,245, 303–310.

  22. Herzer, M., & Hood, K. K. (2010). Anxiety symptoms in adolescents with type 1 diabetes: Association with blood glucose monitoring and glycemic control. Journal of Pediatric Psychology,35(4), 415–425.

  23. Huff, M. B., McClanahan, K. K., & Omar, H. A. (2010). Chronic illness and mental health issues. In E. Bell & J. Merrick (Eds.), Rural child health: International aspects (pp. 171–179). Hauppauge, NY: Nova Science Publishers.

  24. Jones, J. E., Watson, R., Sheth, R., Caplan, R., Koehn, M., Seidenberg, M., & Hermann, B. (2007). Psychiatric comorbidity in children with new onset epilepsy. Developmental Medicine and Child Neurology,49(7), 493–497.

  25. Kearney, J. A., Salley, C. G., & Muriel, A. C. (2015). Standards of psychosocial care for parents of children with cancer. Pediatric Blood & Cancer,62(Suppl 5), S632–S683.

  26. Kersun, L. S., & Shemesh, E. (2007). Depression and anxiety in children at the end of life. Pediatric Clinics of North America,54(5), 691–708.

  27. Kilis-Pstrusinska, K., Medynska, A., Adamczak, P., Balasz-Chmielewska, I., Grenda, R., Kluska-Jozwiak, A., … Zwolinska, D. (2013). Anxiety in children and adolescents with chronic kidney disease: Multicenter national study results. Kidney & Blood Pressure Research,37, 579–587.

  28. Klein, R. G. (1991). Parent-child agreement in clinical assessment of anxiety and other psychopathology: A review. Journal of Anxiety Disorders,5(2), 187–198.

  29. Krain, A. L., & Kendall, P. C. (2000). The role of parental emotional distress in parent report of child anxiety. Journal of Clinical Child & Adolescent Psychology,29(3), 328–335.

  30. Lansky, S. B., List, M. A., Lansky, L. L., Ritter-Sterr, C., & Miller, D. R. (1987). The measurement of performance in childhood cancer patients. Cancer,60(7), 1651–1656.

  31. Lauer, A. L. (2015). Treatment of anxiety and depression in adolescents and young adults with cancer. Journal of Pediatric Oncology Nursing,32(5), 276–283.

  32. Lavigne, J. C., & Faier-Routman, J. (1992). Psychological adjustment to pediatric physical disorders: A meta-analytic review. Journal of Pediatric Psychology,17(2), 133–157.

  33. March, J. S., Parker, J. D., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional anxiety scale for children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry,36(4), 554–565.

  34. Martin, S., Wolters, P., Baldwin, A., Gillespie, A., Dombi, E., Walker, K., & Widemann, B. (2012). Social–emotional functioning of children and adolescents with Neurofibromatosis Type 1 and plexiform neurofibromas: relationships with cognitive, disease, and environmental variables. Journal of Pediatric Psychology,37(7), 713–724.

  35. Miller, L. D., Martinez, Y. J., Shumka, E., & Baker, H. (2014). Multiple informant agreement of child, parent, and teacher ratings of child anxiety within community samples. The Canadian Journal of Psychiatry,59(1), 34–39.

  36. Moore, J. B., & Mosher, R. B. (1997). Adjustment responses of children and their mothers to cancer: Self-care and anxiety. Oncology Nursing Forum,24, 519–525.

  37. 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 comparison with child-report in a clinic and normal sample. Behavior Research and Therapy,42(7), 813–839.

  38. Niditch, L. A. R., & Varela, R. E. (2011). Mother–child disagreement in reports of child anxiety: Effects of child age and maternal anxiety. Journal of Anxiety Disorders,25, 450–455.

  39. Noll, R. B., Reiter-Purtill, J., Moore, B. D., Schorry, E. K., Lovell, A. M., Vannatta, K., & Gerhardt, C. A. (2007). Social, emotional, and behavioral functioning of children with NF1. American Journal of Medical Genetics A,143A, 2261–2273.

  40. Ortega, A. N., Huertas, S. E., Canino, G., Ramirez, R., & Rubio-Stipec, M. (2002). Childhood asthma, chronic illness, and psychiatric disorders. The Journal of Nervous and Mental Disease,190(5), 275–281.

  41. Pao, M., & Bosk, A. (2011). Anxiety in medically ill children/adolescents. Depression and Anxiety,28(1), 40–49.

  42. Pinquart, M., & Shen, Y. (2010). Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis. Journal of Pediatric Psychology,36(4), 375–384.

  43. Platt, R., Williams, S. R., & Ginsburg, G. S. (2016). Stressful life events and child anxiety: Examining parent and child mediators. Child Psychiatry and Human Development,47(1), 23–34.

  44. Popp, L., Neuschwander, M., Mannstadt, S., In-Albon, T., & Schneider, S. (2017). Parent-child diagnostic agreement on anxiety symptoms with a structured diagnostic interview for mental disorders in children. Frontiers in Psychology,8, 404.

  45. Prinzie, P., Descheemaeker, M. J., Vogels, A., Cleymans, T., Haselager, G. J. T., Curfs, L. M. G., et al. (2003). Personality profiles of children and adolescents with neurofibromatosis type 1. American Journal of Medical Genetics A,118A, 1–7.

  46. 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.

  47. Schisler, T., Lander, J., & Fowler-Kerry, S. (1998). Assessing children’s state anxiety. Journal of Pain and Symptoms Management,16(2), 80–86.

  48. Shemesh, E., Annunziato, R. A., Shneider, B. L., Newcorn, J. H., Warshaw, J. K., Dugan, C. A., … Emre, S. (2005). Parents and clinicians underestimate distress and depression in children who had a transplant. Pediatric Transplantation,9, 673–679.

  49. Spielberger, C. D. (1973). State-Trait Anxiety Inventory for children: Manual, test booklet and scoring key. Menlo Park, CA: MindGarden.

  50. Spielberger, C. D. (1983). State-Trait Anxiety Inventory for adults: Manual, instrument, and scoring guide. Menlo Park, CA: MindGarden.

  51. Suikers, E., Tissing, W. J., Brinksma, A., Roodbol, P. F., Kamps, W. A., Stewart, R. E., … Fleer, J. (2015). Providing care to a child with cancer: A longitudinal study on the course, predictors, and impact of caregiving stress during the first year after diagnosis. Psychooncology,24(3), 318–324.

  52. Turkel, S., & Pao, M. (2007). Late consequences of chronic pediatric illness. Psychiatric Clinics of North America,32(4), 483–524.

  53. Vila, G., Nollet-Clémençon, C., de Blic, J., Falissard, B., Mouren-Simeoni, M., & Scheinmann, P. (1999). Assessment of anxiety disorders in asthmatic children. Psychosomatics,40(5), 404–413.

  54. Wiener, L., Battles, H., Bedoya, S. Z., Baldwin, A., & Widemann, B. C. (2018). Identifying symptoms of distress in youth living with neurofibromatosis type 1 (NF1). Journal of Genetic Counseling,27(1), 115–123.

  55. Wiener, L., Battles, H., Zadeh, S., Widemann, B. C., & Pao, M. (2017). Validity, specificity, feasibility and acceptability of a brief pediatric distress thermometer in outpatient clinics. Psychooncology,26(4), 461–468.

  56. Wiener, L., Kazak, A., Noll, R., Patenaude, A., & Kupst, M. (2015). Standards for psychosocial care of children with cancer and their families: An introduction to the special issue. Pediatric Blood & Cancer,62(Suppl 5), S419–S424.

Download references

Acknowledgements

Permission was granted in 2009 by Charles D. Spielberger, Ph.D., of University of South Florida, to develop and test the parent version of the STAI. The authors gratefully acknowledge Haven Battles, Ph.D., for her careful review of this manuscript and the help of Eliza Lanzillo, B.A., of the National Institute of Mental Health.

Funding

This work was supported by the Intramural Programs of the National Cancer Institute and the National Institute of Mental Health at the National Institutes of Health (ZIA-MH002922-09, NCT00824278)

Author information

Correspondence to Lori Wiener.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights

The study was approved by the Combined Neuroscience Institutional Review Board at the National Institute of Mental Health.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shain, L.M., Pao, M., Tipton, M.V. et al. Comparing Parent and Child Self-report Measures of the State-Trait Anxiety Inventory in Children and Adolescents with a Chronic Health Condition. J Clin Psychol Med Settings 27, 173–181 (2020). https://doi.org/10.1007/s10880-019-09631-5

Download citation

Keywords

  • State-Trait Anxiety Inventory
  • State anxiety
  • Parent–child concordance
  • Assessment