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The Youth Anxiety Measure for DSM-5 Child Psychiatry Hum Dev DOI 10.1007/s10578-016-0648-1 ORIGINAL ARTICLE The Youth Anxiety Measure for DSM-5 (YAM-5): Development and First Psychometric Evidence of a New Scale for Assessing Anxiety Disorders Symptoms of Children and Adolescents 1,2,3 4 4 Peter Muris • Ellin Simon • Hester Lijphart • 4 5 3 Arjan Bos • William Hale III • Kelly Schmeitz • International Child and Adolescent Anxiety Assessment Expert Group (ICAAAEG) Ó The Author(s) 2016. This article is published with open access at Springerlink.com Abstract The Youth Anxiety Measure for DSM-5 (YAM- psychometric qualities of the measure: that is, the internal 5) is a new self- and parent-report questionnaire to assess consistency was good for both parts, as well as for most of anxiety disorder symptoms in children and adolescents in the subscales, the parent–child agreement appeared satis- terms of the contemporary classification system. Interna- factory, and there was also evidence for the validity of the tional panels of childhood anxiety researchers and clini- scale. The YAM-5 holds promise as a tool for assessing cians were used to construct a scale consisting of two parts: anxiety disorder symptoms in children and adolescents. part one consists of 28 items and measures the major anxiety disorders including separation anxiety disorder, Keywords Youth Anxiety Measure for DSM-5 Á selective mutism, social anxiety disorder, panic disorder, Questionnaire Á Anxiety disorders symptoms Á Children and and generalized anxiety disorder, whereas part two con- adolescents tains 22 items that focus on specific phobias and (given its overlap with situational phobias) agoraphobia. In general, the face validity of the new scale was good; most of its Introduction items were successfully linked to the intended anxiety disorders. Notable exceptions were the selective mutism Anxiety disorders are among the most prevalent psychiatric items, which were frequently considered as symptoms of problems in children and adolescents. On the basis of a social anxiety disorder, and some specific phobia items large-scale, longitudinal, epidemiological study, it was especially of the natural environment, situational and other concluded that almost 1 in 10 (i.e., 9.9 %) of the young type, that were regularly assigned to an incorrect category. people suffer from one or more anxiety disorders before the A preliminary investigation of the YAM-5 in non-clinical age of 16 [1]. Anxiety disorders cause significant impair- (N = 132) and clinically referred (N = 64) children and ment in youths’ emotional, social, and academic func- adolescents indicated that the measure was easy to com- tioning [2], and typically follow a chronic course, even into plete by youngsters. In addition, support was found for the adulthood [3], while increasing the risk for other types of psychopathology, in particular depression [4]. Given this, research on childhood anxiety disorders is important, and a & Peter Muris considerable number of studies have focused on factors [email protected] involved in the origins of these problems and their effective 1 treatment. On the basis of a review of studies conducted Clinical Psychological Science, Faculty of Psychology and between 1982 and 2006, Muris and Broeren [5] concluded Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands that ‘‘the research on childhood anxiety disorders has made significant advancements’’ (p. 388), and inspection of the 2 Stellenbosch University, Stellenbosch, South Africa 3 more recent literature indicates that this scientific progress Virenze-RIAGG Maastricht, Maastricht, The Netherlands has continued during the last decade. 4 Open University, Heerlen, The Netherlands Self-report questionnaires are widely employed for 5 Utrecht University, Utrecht, The Netherlands measuring the frequency and intensity of anxiety 123 Child Psychiatry Hum Dev symptoms in children and adolescents. This type of measures symptoms of the full spectrum of anxiety disor- assessment is easy to administer, requires a minimum ders that according to DSM-IV may occur in youth. Psy- amount of time, and captures information about anxiety chometric evaluations of these questionnaires have symptoms from the child’s point of view [6]. The latter is generally provided positive evidence for their reliability important because anxiety disorders belong to the category and validity [19], and there are even indications that the of internalizing (emotional) problems, which are often less new scales are superior in some regards (e.g., sensitivity to observable than the externalizing (behavioral) problems measure treatment effects) as compared to the more tra- (such as oppositional-defiant disorder and conduct disor- ditional childhood anxiety questionnaires [20]. der), even to people in the young person’s direct environ- With the publication of DSM-5 [21] various changes in ment. The measurement of anxiety by means of the classification of anxiety disorders have been instituted, questionnaires is particularly useful for researchers who which may have implications for their assessment. First, want to study variations in children’s and adolescents’ obsessive–compulsive disorder and posttraumatic or acute anxiety symptoms in relation to hypothesized vulnerability, stress disorder are no longer considered as pure anxiety risk, and protective factors in order to learn more about the disorders [22, 23] and have been moved to different sec- mechanisms underlying this psychopathology. Further, tions in the DSM, and thus these symptoms no longer need within the context of treatment outcome studies on child- to be captured by childhood anxiety questionnaires. Sec- hood anxiety disorders, such measures are needed in order ond, agoraphobia is now regarded as distinct from panic to quantify the effectiveness of treatment [7]. Besides these disorder [24], and as such may require additional items in purposes, self-report scales are useful in clinical practice or order to strengthen the assessment of this anxiety problem. in community/school settings where they can be efficiently Finally, given increasing evidence that anxiety is a employed to detect fear and anxiety in youths, measure the prominent feature of selective mutism [25], this type of severity of these complaints, and evaluate therapeutic childhood psychopathology is now conceptualized as an progress [8]. anxiety disorder and so standardized assessment should Three of the most commonly used scales for assessing aim to assess for this presentation. symptoms of fear and anxiety in children and adolescents The Anxiety Disorders subgroup of the DSM-5 Anxiety, are the State-Trait Anxiety Inventory for Children [9], the Obsessive–Compulsive Spectrum, Posttraumatic, and Dis- Revised Children’s Manifest Anxiety Scale [10], and the sociative Disorders workgroup developed dimensional Fear Survey Schedule for Children-Revised [11]. Although scales to assess symptoms present in children and adoles- support has been found for the reliability and validity of cents with anxiety disorders [26]. These dimensional scales each of these measures, a clear shortcoming is that they are employ a similar format for each anxiety disorder: first a not directly related to the anxiety disorders as listed in the definition is provided of the disorder, after which 10 uni- commonly employed Diagnostic and Statistical Manual of form questions are asked that assess the frequency of Mental Disorders (DSM). This results in a gap between the cognitive, physiological, and behavioral symptoms asso- outcome of the anxiety assessment and the anxiety disorder ciated with that specific anxiety disorder. A first study classification, which hinders communication about youths’ exploring the psychometric properties of the DSM-5 anxiety problems for both clinicians and researchers. dimensional anxiety scales in 8- to 13-year-old children Moreover, there is evidence that childhood anxiety symp- [27] yielded some positive results for their reliability and toms cluster into categories that are consistent with the validity. However, convergent and discriminant validity of anxiety disorders in the DSM [12], providing empirical the dimensional scales (as investigated through correlations justification for a DSM-based assessment. with corresponding and non-corresponding scales on After the introduction of the DSM-IV [13], several another self-report anxiety scale, the SCARED) were less questionnaires were developed that measure anxiety satisfactory, and this also appeared true for the parent–child symptoms in children and adolescents in terms of the DSM and father–mother agreement indices. Besides these psy- nosology. The Multidimensional Anxiety Scale for Chil- chometric imperfections, the DSM-5 dimensional scales do dren [14], the Screen for Child Anxiety Related Emotional not include selective mutism and only assess symptoms in Disorders (SCARED) [15], and the Spence Children’s relation to one type of specific phobia (the one chosen by Anxiety Scale [16] are psychometrically sound examples the child/adolescent or parent as being most prominent). To of such measures. All these scales assess children’s fear deal with this drawback, the instrument could be easily and anxiety symptoms in relation to stimuli and situations expanded. However, by adding 10 items for each extra that are related to diagnostic categories including separa- anxiety disorder this would result in a fairly large instru- tion anxiety disorder, social anxiety disorder, generalized ment. Further,
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