The Screen for Child Anxiety Related Emotional Disorders – Child version (SCARED Child) is a child self-report scale used to screen for anxiety disorders in children (aged 8-18 years), including generalised anxiety, separation anxiety disorder, panic disorder and social phobia (Birmaher et al., 1997). There is also parent version (SCARED Parent) which asks the parent questions about their child.
The SCARED Child consists of 41 items and has five factors that correspond with anxiety disorders outlined in the DSM:
Example SCARED Child Item
The scale is designed to be used by clinicians as a screener for anxiety disorders in children, and can be used to track symptoms over time. If a child is aged between 8-11 years it is recommended that the clinician explain all questions, or have the child answer the questionnaire sitting with an adult in case they have any questions. It is recommended that both the parent and child version of the SCARED are administered due to the moderate correlation between the two versions.
The SCARED Child items are summed to obtain a raw score for the total and each of the five subscales. Average scores are also presented to allow for a comparison between subscales. Higher scores indicate higher levels of anxiety.
A total score of 25 or more may indicate the presence of an anxiety disorder.
Five factor scores are presented with associated cut-offs:
Two percentiles are presented to indicate how the SCARED Child Version scores compare to a group of children and adolescents with a diagnosed anxiety disorder and a community sample. A percentile of 50 compared to the Anxiety Sample is typical for children presenting with an anxiety disorder, which will correspond to a percentile compared to the Community Sample of approximately 95.
On first administration of the SCARED Child two plots are presented: (i) a plot showing the total and subscale percentiles compared to the anxiety sample so that the severity of each subscale can be compared, and (ii) an average score plot to enable a comparison between subscales. Upon multiple administration the progress of therapy can be tracked using two scales: (i) a plot showing the change in the subscale and total percentiles and (ii) the change in average scores.
The 41 item version of the SCARED was developed by Birmaher and colleagues (1999). The scale was administered to 190 children and adolescents attending an outpatient mood/anxiety disorders clinic and their parents. The 190 children and adolescents were diagnosed with either an ‘anxiety’ (n = 45) or ‘nonanxiety’ (n = 145) disorder by a trained clinician.
Factor analysis yielded five subscales; (somatic/panic, general anxiety, separation anxiety, social phobia and school phobia). Moderate correlations were found between the parent and child version (Birmaher et al., 1999). A cut-off score for the total score and each subscale was suggested by the test developers and were chosen based on scores which yielded the highest sensitivity and specificity.
The sample of 45 children and adolescents with anxiety disorders (aged 9 -19) had a mean total score of 36.1 (17.3), a mean somatic/panic score of 9.4 (6.6), a mean general anxiety score of 9.4 (5.8), a mean separation anxiety score of 5.4 (4.0), a mean social phobia score of 8.0 (4.2) and a mean school phobia score of 3.9 (2.7) (Birmaher et al., 1999).
A non-clinical community sample of 521 children and adolescents, aged 12-18, had a mean total score of 16.1 (12.6), a mean somatic/panic score of 2.8 (3.9), a mean general anxiety score of 4.9 (4.3), a mean separation anxiety score of 2.4 (2.5), a mean social phobia score of 4.8 (3.7) and a mean school phobia score of 1.2 (1.6) (Muris et al., 200).
The SCARED has demonstrated good discriminate validity. Findings indicated that the total score and score for each of the five factors of the child SCARED significantly differentiated children with anxiety disorders from children with other disorders. Similar results were found for the total score and the panic/somatic and separation anxiety factor scores of the parent SCARED. For the most part scales on both the parent and child version of the SCARED were also able to significantly differentiate between anxiety disorders (Birmaher et al., 1999).
Many studies have confirmed the validity and reliability of the SCARED in both clinical and community samples (Hale et al., 2011).
Using both the SCARED Parent and SCARED Child versions provides a more comprehensive picture of the child’s anxiety symptoms. Children and parents often report different symptoms – children may be more aware of their internal experiences like worried thoughts and physical sensations, whilst parents may better observe behavioural signs like avoidance or school refusal. Research shows that parent-child agreement on anxiety symptoms is often moderate at best, with parents sometimes underreporting internalising symptoms their child experiences privately. Additionally, some children may minimise symptoms due to embarrassment or fear of consequences, whilst others might struggle to articulate their experiences. By comparing both perspectives, clinicians can identify discrepancies that warrant further exploration and ensure important symptoms aren’t missed. This dual-informant approach is particularly valuable for younger children who may have limited insight or vocabulary to describe anxiety symptoms.
The SCARED’s five subscales help differentiate between anxiety disorders, which is crucial for treatment planning. The Somatic/Panic subscale identifies children experiencing physical anxiety symptoms like breathing difficulties or feeling faint, suggesting possible panic disorder. The General Anxiety subscale captures excessive worry across multiple domains, indicating potential generalised anxiety disorder. Separation Anxiety measures distress about being apart from attachment figures, whilst Social Phobia identifies fears in social or performance situations. The School Avoidance subscale specifically flags anxiety-related school refusal, which often requires immediate intervention. Understanding which subscales are elevated helps clinicians tailor interventions – for instance, high separation anxiety scores might indicate family-based interventions, whilst elevated social phobia scores suggest social skills training or gradual exposure to social situations.
When a child’s total SCARED score falls just below the overall clinical cut-off of 25, or when individual subscale scores are slightly elevated but don’t meet thresholds, clinical judgment becomes essential. These scores shouldn’t be dismissed, as they may indicate subclinical anxiety that could worsen without intervention, especially during stressful periods like school transitions or family changes. Consider the child’s age – younger children might not yet fully express anxiety symptoms that will become more apparent as they develop. Also examine the pattern across subscales; multiple slightly elevated subscales might be more concerning than one isolated elevation. The child’s functional impairment is key – if anxiety is interfering with school attendance, friendships, or family life, intervention may be warranted regardless of scores. Regular monitoring with the SCARED can track whether subclinical symptoms are stable, improving, or escalating toward clinical levels.
The SCARED provides two percentile comparisons that serve different clinical purposes. The percentile compared to other anxious children shows severity within a clinical population – a child at the 50th percentile compared to the anxiety sample has typical anxiety levels for someone seeking treatment, whilst scores at the 80th percentile or above indicate more severe anxiety even among anxious youth. The community percentile shows how unusual the child’s anxiety is compared to the general population – scores above the 95th percentile (affecting only 5% of children) clearly indicate clinical concern. This dual comparison helps with treatment planning: a child at the 30th percentile for anxiety but 90th for community might benefit from brief intervention or group therapy, whilst someone at the 85th percentile for anxiety likely needs intensive individual treatment. The percentile scores also help communicate with families – explaining that their child’s anxiety is “higher than 99% of children their age” can validate parental concerns and motivate engagement with treatment.
The SCARED’s specific focus on anxiety symptoms helps distinguish anxiety from conditions that may present similarly in children. Unlike broad behavioural checklists, the SCARED captures the worry, fear, and physical anxiety symptoms that might be missed when focusing on externalising behaviours. For instance, a child with ADHD might appear restless and have school difficulties, but the SCARED can reveal whether underlying anxiety about academic performance contributes to these behaviours. The physical symptom items (headaches, stomachaches at school) help identify children whose somatic complaints are anxiety-driven rather than medical in nature. Depression and anxiety often co-occur in children, but the SCARED’s specific items about worry, fear of specific situations, and panic symptoms help tease apart anxiety from the sadness and anhedonia of depression. This differentiation is crucial because anxiety disorders in children respond well to specific interventions like cognitive-behavioural therapy, and untreated childhood anxiety is a major risk factor for later depression.
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. https://doi.org/10.1097/00004583-199704000-00018
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. https://doi.org/10.1097/00004583-199704000-00018
Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. Journal of the American academy of child & adolescent psychiatry, 38(10), 1230-1236. https://doi.org/10.1097/00004583-199910000-00011
Hale, W. W., 3rd, Crocetti, E., Raaijmakers, Q. A., & Meeus, W. H. (2011). A meta-analysis of the cross-cultural psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED). Journal of child psychology and psychiatry, and allied disciplines, 52(1), 80–90. https://doi.org/10.1111/j.1469-7610.2010.02285.x
Muris, P., Merckelbach, H., Ollendick, T., King, N., & Bogie, N. (2002). Three traditional and three new childhood anxiety questionnaires: their reliability and validity in a normal adolescent sample. Behaviour research and therapy, 40(7), 753–772. https://doi.org/10.1016/s0005-7967(01)00056-0
