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Behavior Modification
DOI: 10.1177/01454455062970162007; 31; 174Behav Modif
Melinda F. CannonCarl F. Weems, Natalie M. Costa, Sarah E. Watts, Leslie K. Taylor and
SymptomsTheir Unique and Specific Associations With Childhood Anxiety
Cognitive Errors, Anxiety Sensitivity, and Anxiety Control Beliefs:
http://bmo.sagepub.com/cgi/content/abstract/31/2/174The online version of this article can be found at:
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174
Cognitive Errors, AnxietySensitivity, and AnxietyControl Beliefs
Their Unique and Specific
Associations With Childhood
Anxiety Symptoms
Carl F. WeemsNatalie M. CostaSarah E. WattsLeslie K. TaylorMelinda F. CannonUniversity of New Orleans, LA
This study examined the interrelations among negative cognitive errors, anxiety
sensitivity, and anxiety control beliefs and explored their unique and specific
associations with anxiety symptoms in a community sample of youth. Existing
research has suggested that these constructs are related to childhood anxiety dis-
order symptoms; however, additional research is needed to test the interrelations
among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs
and to determine if they show unique and specific associations with anxiety
symptoms. The results of this study indicated that negative cognitive errors, anx-
iety sensitivity, and anxiety control beliefs were associated with each other and
that they demonstrated unique concurrent associations with childhood anxiety
disorder symptoms. Moreover, certain cognitive biases showed specificity in
their association with anxiety symptoms versus depressive symptoms.
Keywords: anxiety; child and adolescents; cognition; anxiety sensitivity;
cognitive errors; control
Anxiety has been broadly conceptualized as a complex response system
involving behavioral, physiological, and cognitive components (e.g.,Barlow, 2002; Lang, 1977). Anxiety disorders are thought to result from
quantitative and/or qualitative deviations in the normative mechanisms of
the anxiety response system (Barlow, 2002; Vasey & Dadds, 2001). Cognitive
models focus on the hypothesis that anxiety disorders can stem from faulty,
Behavior Modification
Volume 31 Number 2
March 2007 174-201
2007 Sage Publications
10.1177/0145445506297016
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Weems et al. / Childhood Anxiety 175
biased, or negative ways of thinking and the biased processing of information
(e.g., Beck, 1976; Ellis, 1962). Although a large number of studies have
shown that cognitive biases are associated with depression in youth and thatvarious forms of biases may help predict depressive symptoms (Garber,
Keiley, & Martin, 2002; see Joiner & Wagner, 1995, for a review), far less
research has been focused on their role in childhood anxiety. Alfano,
Beidel, and Turner (2002) have argued that the literature to date has only
provided modest support for a role of cognitive aberrations (p. 1209) or
cognitive biases in childhood anxiety and anxiety disorders. In particular,
the empirical support for the conceptual distinctions among various cogni-
tive biases and their specificity to anxiety is limited (Weems & Watts, 2005).The purpose of this study was to address some of these gaps in knowledge.
The research on cognitive models of anxiety in youth has focused on biased
interpretation, biased judgment, biased memory, and selective attention (see,
e.g., Vasey & MacLeod, 2001). These various biases are hypothesized to work
together at various stages of information processing to foster and maintain
heightened anxiety. Weems and Watts (2005) developed a model of the cogni-
tive influences on childhood anxiety, which suggests that attention biases may
foster the selective encoding of threat information into memory and that suchselective attention could thus increase the number of negatively biased threat
memories. Memory biases, in turn, may become internalized in cognitive
working models or cognitive schemas, thus fostering interpretive and judg-
ment biases. For example, existing threat memories may bias attention toward
only the threatening part of the situation and away from mitigating aspects of
the situation such as safety signals, thereby fostering anxiety-provoking inter-
pretations. Another way is that existing threat memories may bias the new
interpretation of the event and help to consolidate existing interpretation and
judgment biases. The model thus predicts that the various cognitive biases will
be related to each other but, at least to some extent, will each be incrementally
related to anxiety and anxiety-related distress.
Conceptually, attention and memory are quite distinct and research sug-
gests that they show unique associations with anxiety in youth (Watts &
Weems, in press); however, judgment biases and interpretation biases are very
similar and our review of the literature (see Weems & Watts, 2005) suggests
that additional research and conceptual work is needed to elucidate the
Authors Note: This research was supported in part by a grant from the National Institute of
Mental Health (MH067572) awarded to Carl F. Weems. Correspondence concerning this arti-
cle should be addressed to Carl F. Weems, Department of Psychology, University of New
Orleans, New Orleans, LA 70148; e-mail: [email protected].
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176 Behavior Modification
uniqueness of the concepts and the uniqueness of the associations among
judgment biases, interpretation biases, and anxiety in youth. Interpretive
bias involves being predisposed toward negative or erroneous interpreta-tions of neutral, ambiguous, or potentially threatening stimuli or situations.
Judgment bias involves negative and/or lowered estimates of the individ-
uals coping ability or style. Both interpretive and judgment biases thus
involve a similar cognitive style and so individuals who have a tendency for
negative judgments about their own ability are likely to have negative inter-
pretations of events (and vice versa), and so interpretive and judgment
biases are likely to be related. However, this similarity also raises the pos-
sibility that they are not uniquely associated with anxiety (i.e., variance inone may account for the association between anxiety and the other). The
focus of this study is on two types of interpretive biasesnegative cogni-
tive errors and anxiety sensitivityand a judgment bias, namely, anxiety
control beliefs. These three constructs were chosen because they have been
hypothesized to be important to childhood anxiety problems (e.g., Epkins,
1996; Weems & Silverman, 2006).
Interpretive Biases
As noted, interpretive bias involves being predisposed toward negative
or erroneous interpretations of neutral, ambiguous, or potentially threaten-
ing stimuli or situations. Negatively biased cognitions1 have long been
thought to be core processes in emotional problems such as anxiety disor-
ders (Beck, 1976; Ellis, 1962). Research has shown that clinically anxious
youth presented with ambiguous vignettes and then asked to explain what
was happening in the story are more likely to provide interpretations indi-cating threat than are nonanxious controls (Barrett, Rapee, Dadds, & Ryan,
1996; Chorpita, Albano, & Barlow, 1996).
Negative cognitive errors are thought to be particularly salient to emo-
tional problems in youth (Leitenberg, Leonard, & Carroll-Wilson, 1986)
and concern the interpretation of events and situations in ones life. For
example, catastrophizing involves expecting the worst possible outcome of
an event or situation, overgeneralizing involves believing that a single neg-
ative outcome is representative of all similar future events, personalizinginvolves attributing control over the outcome of negative events to internal
causes, and selective abstraction involves selectively focusing on only the
negative aspects of an event or situation. The existing research on these
cognitive errors using the Childrens Negative Cognitive Error Questionnaire
(CNCEQ; Leitenberg et al., 1986) suggests that they are associated with
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symptoms of anxiety and depression and that certain errors, such as cata-
strophizing and overgeneralizing, may be more related to anxiety, whereas
selective abstraction may be more related to depression (Epkins, 1996;Leitenberg et al., 1986; Leung & Wong, 1998; Weems, Berman, Silverman,
& Saavedra, 2001). However, as theoretically predicted by the cognitive con-
tent specificity hypothesis (Beck, 1976; Beck, Brown, Steer, Eidelson, &
Riskind, 1987; Laurent & Stark, 1993), greater specificity has been obtained
when the content of the cognitions are centered on depressive versus anx-
ious content (Leung & Poon, 2001). Such findings suggest that it is not the
type of bias per se that is specific to anxiety but the content of the bias (see
also Laurent & Stark, 1993).Catastrophic interpretations of anxiety-related sensations have been the
focus of the literature on anxiety sensitivity. The concept of anxiety sensi-
tivity refers to beliefs that anxiety-related sensations have severe and nega-
tive consequences (Reiss, 1991). Defined in this way, anxiety sensitivity
provides specificity to the concept of catastrophizing by focusing on anxiety-
related events and situations. Research indicates that anxiety sensitivity pre-
dicts panic beyond that predicted by trait anxiety in adult samples (e.g.,
Schmidt, Lerew, & Jackson, 1997, 1999), prospectively predicts the devel-opment of panic attacks in youth (Hayward, Killen, Kraemer, & Taylor,
2000; Weems, Hayward, Killen, & Taylor, 2002), and that anxiety sensitiv-
ity is concurrently and prospectively related to self-report of anxiety and
panic symptoms (Ginsberg & Drake, 2002; Lau, Calamari, & Waraczynski,
1996; Silverman, Fleisig, Rabian, & Peterson, 1991). Moreover, studies
have demonstrated that although anxiety sensitivity is related to depression,
it is more uniquely associated with anxiety symptoms in youth (see Dehon,
Weems, Stickle, Costa, & Berman, 2005; Joiner et al., 2002).
Weems et al. (2001) examined the association between negative cogni-
tive errors assessed with the CNCEQ and anxiety symptoms as well as anx-
iety sensitivity assessed with the Childhood Anxiety Sensitivity Index
(Silverman et al., 1991) in a sample of children and adolescents who were
clinic referred for anxiety disorders (N = 251, ages 6-16 years). Resultsindicated that the types of errors, except selective abstraction, were signif-
icantly positively related to self-reported anxiety and anxiety sensitivity
even when controlling for levels of depression (correlations ranged from
.39 to .43). Results of regression analyses indicated that age moderated therelation between the cognitive errors and anxiety. The pattern that emerged
was statistically significant but there were somewhat smaller correlations
between CNCEQ subscale scores and the anxiety measures in children
ages 6 to 11 (average r = ~.35) than adolescents ages 12 to 17 years
Weems et al. / Childhood Anxiety 177
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(average r= ~.45). These results suggest that for younger children withanxiety disorders, negative cognitive errors were less strongly related to
their anxious symptoms than for older youth with anxiety disorders.Additional results indicated that selective abstraction was more uniquely
associated with depression and that catastrophizing and overgeneralizing
were more uniquely associated with anxiety symptoms. However, the
unique associations among anxiety, anxiety sensitivity, and CNCEQ scores
were not examined.
Judgment Biases
As noted, judgment bias involves negative and/or lowered estimates of the
individuals coping ability or style. Judgment biases in children can refer to
lowered expectations of their ability to handle threatening situations or
events. Common definitions of control involve a judgment as to ones ability
and have thus been the most common way that judgment biases have been
studied in youth. Barlows (2002) model of anxiety suggests that a perceived
lack of control over external threats (i.e., events, objects, or situations that are
fear producing for an individual) and/or control over negative internal emo-
tional and bodily reactions are central to the experience of anxiety problems;
that is, beliefs that anxiety-related events and sensations are uncontrollable is
part of what makes anxiety a problem for individuals with anxiety disorders.
In other words, nonpathological anxiety in individuals who do not have anx-
iety disorders is differentiated from pathological anxiety by heightened levels
of anxiety in response to the experience of threatening situations but also by
the judgment that they cannot control these events.
Research on control and anxiety has produced an encouraging body ofknowledge. For example, studies suggest that there seems to be a fairly con-
sistent relation between an external locus of control and self-reported anx-
iety in children (Nunn, 1988; Rawson, 1992). Similar findings also have
been evidenced using diverse methods of assessing control (e.g., Capps,
Sigman, Sena, Henker, & Whalen, 1996; Cortez & Bugental, 1995). However,
control is also strongly related to depression as well as anxiety (see Joiner
& Wagner, 1995).
Barlow and colleagues(Barlow, 2002; Rapee, Craske, Brown, & Barlow,1996) model of control provides a more anxiety-specific conceptualization.
Drawing on Barlows (2002) model of control in anxiety disorders, Rapee
et al. (1996) developed a measure of control over anxiety, the Anxiety Control
Questionnaire (ACQ), for use with adults. Ones perception of control over
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anxiety-related events is assessed by the ACQ in terms of control over emo-
tional reactions and frightening events. Specifically, in the ACQ, the internal-
external distinction refers to the stimuli to be controlled (i.e., internal anxietyreactions such as heart palpitations or feelings of panic; external threats
such as a dog or social situations).
Weems, Silverman, Rapee, and Pina (2003) investigated the role of con-
trol beliefs in childhood anxiety disorders using a developmentally modi-
fied version of Rapee et al.s (1996) Anxiety Control Questionnaire (i.e., the
ACQ-C) in a sample of 117 youth ages 9 to17 years. Eighty-six participants
were clinic referred and met diagnostic criteria for an anxiety disorder, and
31 participants were nonreferred comparison participants. Findings indi-cated that perceived control over anxiety-related events was significantly
negatively correlated with youth self-reported anxiety symptoms and that
youth with anxiety disorders reported significantly lower perceived control
about anxiety than the nonreferred youth. Results of logistic regression
analysis indicated that the perceptions of control over anxiety predicted
anxiety disorder status even when controlling for anxiety levels using an
existing measure of anxiety as well as locus of control. Although this initial
research is encouraging, the specificity of anxiety control beliefs to anxietyversus depression and its association to other forms of cognitive bias has
not been examined.
Summary
There is evidence that negative cognitive errors, anxiety sensitivity, and
anxiety control beliefs are associated with anxiety in youth. However,
research is needed to examine the interrelations among negative cognitiveerrors, anxiety sensitivity, and anxiety control beliefs and to examine if they
are each uniquely associated with anxiety. For example, anxiety sensitivitys
association with anxiety may be explained by the more general cognitive
bias of catastrophizing. Similarly, it could be argued that personalizing or
attributing control over the outcome of negative events to internal causes is
tapping the same cognitive process as control over anxiety. Moreover, the
judgment that anxiety sensations are uncontrollable might be tapping the
same beliefs that are central to anxiety sensitivity (i.e., they are not empiri-cally unique). Theoretically, biases such as control over anxiety involve a
perceived lack of ability, competence, or skill and are thus centered on the
individual making the judgment, whereas interpretive biases involve dispro-
portionately negative interpretations of stimuli or situations and are thus
Weems et al. / Childhood Anxiety 179
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centered on a context, stimuli, or external event (i.e., they theoretically should
be empirically unique predictors of anxiety). According to the cognitive con-
tent specificity hypothesis (Beck et al., 1987), the concepts of anxiety sensi-tivity and anxiety control should show greater specificity to anxiety than
depression. Without research that tests the uniqueness and specificity of
these constructs (e.g., Do measures of personalizing, catastrophizing, anxi-
ety sensitivity, and control predict unique variance in anxiety symptoms and
how specific are they to anxiety symptoms vs. depression?), the conceptual
validity of the constructs remains questionable.
The Present Study
The purpose of this study was to extend existing research by examining
the interrelations among negative cognitive errors, anxiety sensitivity, and
anxiety control beliefs and by examining their unique associations with
anxiety symptoms in a community sample of youth. Based on the model
proposed by Weems and Watts (2005), theoretical basis for the constructs,
and existing research, we predicted that catastrophizing, anxiety sensitivity,
and anxiety control would each predict unique variance in anxiety disordersymptoms. We also hypothesized that anxiety sensitivity and anxiety con-
trol would show specific associations with anxiety (i.e., would be related to
anxiety even when controlling for depression). Based on previous research,
we predicted that selective abstraction would show unique prediction of
symptoms of depression (e.g., Epkins, 1996; Weems et al., 2001). We also
examined the 1-year test-retest reliability of the measures of negative cog-
nitive errors (CNCEQ), anxiety sensitivity (Childhood Anxiety Sensitivity
Index [CASI]), and anxiety control beliefs (ACQ-C) and examined if thesepredicted anxiety symptoms after 1 year in a subsample (n = 52) of thechild participants.
Given the role that age may play in the associations, we recruited a sam-
ple of youth from a wide age range. This was done so that the potential
moderating role of age could be examined. Based on previous findings in
the depression literature (e.g., Nolen-Hoeksema, Girgus, & Seligman,
1992; Turner & Cole, 1994) and previous research (Calamari et al., 2001;
Rabian, Embry, & MacIntyre, 1999; Weems et al., 2001; Weems, Hammond-Laurence, Silverman, & Ginsburg, 1998), we expected some moderation of
CNCEQ subscales by age, but not anxiety sensitivity. In the absence of any
data on the ACQ-C, we did not make a priori predictions. By using the term
some moderation, we expected that the association would be weaker but
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Weems et al. / Childhood Anxiety 181
that the measures of cognitive biases would still be significantly associated
with anxiety in younger children. However, we expected that age-related
differences in the size of the association between cognitive biases and anx-iety may be specific to clinical samples because of overall larger effect sizes
in such samples. The potential moderating role of gender and ethnicity also
was tested; however, based on Weems et al. (2001), we expected that gender
would not be a moderator. The moderating role of ethnicity was examined
for exploratory purposes in response to the call for greater attention to eth-
nic differences in childhood anxiety research (Cooley & Boyce, 2004).
In addition, although youth are probably in the best position to report on
their cognitions, reliance solely on self-report of anxiety symptoms in test-ing the validity of these measures may have biased estimates of the associ-
ation. However, there tends to be fairly low correspondence between parent
and child reports of the childs behavior (e.g., Achenbach, McConaughy, &
Howell, 1987, in a review of the literature, report an average correlation of
r= .25). Such discrepancies among reporters can lead to different or incon-sistent conclusions about the prediction of behavioral problems (De Los
Reyes & Kazdin, 2004). Reasons for the bias in reporting anxiety symp-
toms may stem from the parent or from the child. For example, bias may bedue to the child underreporting his or her own anxiety for reasons of social
desirability, or parents may underreport relative to the child because the
nature of anxiety makes it less salient to parents and thus they are not aware
of true levels of anxiety in their child. De Los Reyes and Kazdin (2004)
recently examined different options for examining informant discrepancies.
They concluded that the standardized difference between reporters is a pre-
ferred measure of discrepancy between parent and child reports because it
correlates equally with each of the sources from which it is derived.
Drawing from this recommendation, we employed a technique for handling
discrepancy when predicting parent-reported symptoms with child-reported
cognitive biases. Results obtained from parents alone and from combining
parent and child reports of the childs anxiety also are presented.
Method
ParticipantsData were collected from a socioeconomic and ethnically diverse sample
of 145 youth (ages 6-17 years, Mage = 11.36 years, SD = 3.5 years)2 andtheir primary caregiver (mothers = 90%, fathers = 7%, grandparents = 3%).
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Participants were Euro-American (42%), African American (42%), Hispanic
(8%), Asian (2%), and 6% were of other or mixed ethnic backgrounds, with
a median family income of between $20,000 and $40,000 a year. Fifty-fivepercent of the sample was female. Families were recruited through the adult
students enrolled in courses at the University of New Orleans (UNO) as
well as through area schools and media outreach. Participants received a
small monetary reward as compensation for participating in the research
study (paid to the parent for the child).
Children were excluded if parents indicated during an initial assessment
screening that the child had a history of one or more of the following
diagnosesall pervasive developmental disorders, mental retardation, selec-tive mutism, organic mental disorders, schizophrenia, and other psychotic
disordersor were at risk for harm to self or others (only one child was
excluded whose parent indicated the child had a diagnosis of pervasive
developmental disordernot otherwise specified [PDD-NOS]). Interested
families were informed that we were conducting a study of youth behav-
iors, emotions, and anxiety and that they could receive a free screening for
anxiety-related problems. However, potential participants were told that
families are eligible to participate regardless of whether they have anxietyproblems. This recruitment process was designed to help normalize the dis-
tribution of anxiety symptoms to facilitate the use of parametric statistics.
However, only 6% of children or mothers were currently on any form of
psychotropic medications. On the basis of our assessment, 9 children (6%)
were referred to further assessment or intervention services. All data used
in this study were collected before families were referred to or enrolled in
intervention services.
A representative subsample (n = 52)3 of the child participants completedthe measures again approximately 1 year (11-14 months) after the initial
assessment to obtain 1-year test-retest reliability estimates and to examine
the predictive ability of negative cognitive errors, anxiety sensitivity, and
anxiety control beliefs. The mean age of the follow-up sample at Time 1
was 11.15 years (SD = 3.2 years). Participants were Euro-American (42%),African American (46%), Hispanic (7%), and 4% were of other or mixed
ethnic backgrounds, with a median family income of between $20,000 and
$40,000 a year. Sixty-one percent of the sample was female. Completers of
this Time 2 follow-up were compared to the rest of the sample on Time 1variables. The follow-up sample did not differ on age, gender, overall eth-
nic distribution, income, anxiety, and depression scores or any of the cog-
nitive variables.
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Measures
The CNCEQ (Leitenberg et al., 1986) was used to assess catastrophiz-ing, overgeneralization, personalizing, and selective abstraction. This
24-item measure is designed to assess the four errors via four theoretically
derived subscales. Each subscale contains six questions. Each item on each
subscale presents the child with a hypothetical vignette and a negative inter-
pretation of the vignette to which the child responds if he or she would
interpret the situation in a similar fashion. For example, one of the items
assessing selective abstraction has the hypothetical situation of playing bas-
ketball where it is indicated that during the game the child scored five bas-
kets and missed two easy shots. After the game, the child thought, I played
poorly. Children are asked to rate on a 5-point scale how similar the
thought was to their own thoughts in a similar situation (e.g., 1 = not at alllike I would think, 5 = almost exactly like I would think). The CNCEQ hasdemonstrated acceptable internal consistency, test-retest reliability, and
construct validity estimates (Leitenberg et al., 1986; Weems et al., 2001).
For example, in terms of convergent validity, Mazur, Wolchik, and Sandler
(1992) found that total distortion scores were significantly related to
childrens anxiety scores as measured by the Revised Childrens ManifestAnxiety Scale (RCMAS) while controlling for gender using partial corre-
lations (partial r= .28).The CASI (Silverman et al., 1991) was used to assess anxiety sensitiv-
ity. The CASI is an 18-item measure designed to assess childrens fear of
different symptoms of anxiety. Children rate each question by selecting one
of three choices (none, some, or a lot). Each item is scored with a 1, 2, or
3. Example questions are, It scares me when I feel shaky and It scares
me when I feel nervous. The CASI has been shown to have satisfactoryreliability estimates (Silverman et al., 1991). For example, Cronbachs
alpha coefficient has been estimated at .87 and 2-week test-retest reliability
at .76. With regard to validity, the CASI has been shown to (a) concurrently
relate to panic symptoms, fears, and negative cognitive errors; (b) predict
anxiety-relevant responding to behavioral-stress challenge tasks; and (c) be
prospectively associated with panic symptoms (e.g., Ginsburg & Drake,
2002; Lau et al., 1996; Rabian et al., 1999; Silverman et al., 1991; Weems
et al., 2001).The ACQ-C (Weems et al., 2003) was developed by adapting the method
used in Rapee et al. (1996). Questions were designed to measure perceived
lack of control over external threats (e.g., events, objects, or situations that
are fear producing for an individual) and control over negative, internal,
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emotional, and bodily reactions associated with anxiety (e.g., shaking or
trembling, the subjective experience of anxiety). In adapting the methods
used by Rapee et al. (1996), Rapee et al.s items were subjected to a devel-opmental analysis of the wording by the authors and modified to render
them understandable by children. For example, phrasing and wording on
the question, There is little I can do to influence peoples judgments of
me was changed to I can change the way that people feel about me.
Children were asked to rate their agreement with each question along a
rating scale as follows: 0 (none), 1 (a little), 2 (some), 3 (a lot), or 4 (very, very
much). Total control belief score is obtained by summing the items. Internal
consistency estimates (i.e., coefficient alpha) for the total scale were .94and .92 in two independent samples (Weems et al., 2003). The ACQ-C also
has produced good validity estimates. For example, the ACQ-C had con-
vergent validity with the NSLOC (r= .22) and RCMAS (r= .47).The Revised Child Anxiety and Depression Scales (RCADS; Chorpita,
Yim, Moffitt, Umemoto, & Francis, 2000; Spence, 1997) were used to
assess symptoms of anxiety disorders and depression. The RCADS is a
47-item instrument that assesses symptoms of each anxiety disorder (except
posttraumatic stress disorder [PTSD] and specific phobias) and depressionbased on the Diagnostic and Statistical Manual of Mental DisordersIV
(DSM-IV) criteria (American Psychiatric Association, 1994). The scale is
scored 1 (never), 2 (sometimes), 3 (often), and 4 (always). The RCADS is
an adaptation of the Spence Anxiety Scales (Spence, 1997). Chorpita et al.
(2000) modified the Spence scales forDSM-IVand evaluated the RCADS
by examining the measures factorial validity in a school sample of 1,641
children and adolescents (ages 6.2-18.9 years) and its reliability and validity
in an independent sample of 246 children and adolescents (ages 8.3-18.3 yrs).
The results suggested an item set and factor definitions that were consistent
with DSM-IV anxiety disorders and depression. Moreover, the RCADS
demonstrated convergent validity with existing measures of childhood anx-
iety and depression (Chorpita et al., 2000).
Parents also completed a parent version of the RCADS (RCADS-P)
designed identical to the RCADS with minor modifications (i.e., wording
was changed from I to My child). Because the RCADS-P has not been
used before, the Revised Childrens Manifest Anxiety Scale (RCMAS-P)
was completed by parents (Pina, Silverman, Saavedra, & Weems, 2001;Reynolds & Richmond, 1978) and was administered to assess convergent
validity with the RCADS-P. The RCMAS-P has good validity estimates
(Pina et al., 2001) and asks parents to rate their childs anxiety with virtu-
ally the same items as the RCMAS (i.e., wording is changed from I to
184 Behavior Modification
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Weems et al. / Childhood Anxiety 185
My child), and thus, 28 items are summed from yes or no responses to
yield a Total Anxiety score (nine items comprise a lie scale). Each item is
scored with a 0 or 1. Convergent validity of the RCADS-P anxiety scalewith the RCMAS-P was .81 in the full sample, .78 in the youth ages 6 to 11
years, and .84 in the youth ages 12 to 17 years (allps < .01). Cross-informantvalidity of the RCADS-P anxiety scale with the RCADS anxiety was .27 in
the full sample, .25 in the youth ages 6 to 11 years, and .27 in the youth ages
12 to 17 years (allps < .05). RCADS-P depression scale was significantlycorrelated with RCMAS-P scores: .73 in the full sample, .69 in the youth
ages 6 to 11 years, and .80 in the youth ages 12 to 17 years (allps < .01).
Procedures
Informed consent was obtained from the parent and informed assent was
obtained from the child. Completion of the assessment took place in a quiet
room and the child completed the assessment in a separate room from the
parent. Both the youth and parent were greeted and given a general
overview of the assessment procedures. Standardized specific instructions
were then given to the parent and child separately. Youth completed themeasures and were assisted as necessary by trained research assistants (e.g.,
young participants were read the assessment battery by research assistants
who monitored the childs comprehension of the questions). At the conclu-
sion of the study, participants were debriefed and given a small monetary
reward. Missing or incomplete data on one or more measures was handled
by pair- or analysis-wise (when more than two variables) deletion of miss-
ing cases (Tabachnick & Fidell, 2001). Age groups4 (children, ages 6-11
years, and adolescents, ages 12-17) were formed on the basis of sample
size, predicted change in cognitive development (Piaget, 1950, 1983), and
for consistency with past research for dichotomous age analyses.
Results
Preliminary Analyses
Means and standard deviations for each of the measures for the total
sample and by age and gender are presented in Table 1. Examination of thecognitive and symptom scores ranges and skew indicated acceptable levels
for the planned analyses. Results of 2 (gender) 2 (age group) ANOVAsare summarized in Table 1 and indicated that boys and girls differed on
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186 Behavior Modification
RCADS anxiety scores, CASI scores, and ACQ-C scores and that the age
groups differed on RCADS anxiety and CASI scores. Because the sample
sizes for the other ethnicities were small, the role of ethnicity was consid-
ered separately and only the African American and Euro-American partici-
pants were used for the ethnic comparisons. Results ofttests indicated that
African American and Euro-American participants significantly differed on
CNCEQ catastrophizing (African American M = 13.16, SD = 5.5; Euro-AmericanM= 11.01, SD = 4.0), t(120) = 2.46,p < .05; CNCEQ personal-izing (African AmericanM= 14.69, SD = 5.4; Euro-AmericanM= 12.43,SD = 4.4), t(120) = 2.44, p < .05; CASI (African American M = 31.77,SD = 6.2; Euro-American M= 27.34, SD = 6.8), t(120) = 3.76, p < .001;and RCADS anxiety (African American M = 69.72, SD =17.9; Euro-
AmericanM=59.39, SD =14.7), t(120) = 3.48,p < .01.Pearsons correlations among the measures and internal consistency are
presented in Table 2 and indicated that child-reported RCADS anxiety
scores were significantly but modestly correlated with each of the cognitive
measures. RCADS anxiety was significantly and highly correlated with
Table 1
Means and Standard Deviations for Cognitive and Symptom
Measures by Age and Gender
Full Sample 6-11 Years 12-17 Years Boys Girls
Measure M(SD) M(SD) M(SD) M(SD) M(SD)
1. RCADS-(A)a,b 64.15 (16.7) 68.90 (17.6) 58.83 (14.0) 59.83 (16.1) 67.79 (16.5)
2. RCADS-(PA) 51.55 (10.3) 52.48 (10.0) 50.33 (10.8) 51.51 (10.6) 51.58 (10.2)
3. CASIa,b 29.31 (6.9) 31.25 (6.8) 27.19 (6.4) 26.89 (6.3) 31.30 (6.8)
4. ACQ-Cb 71.03 (20.1) 70.51 (19.2) 71.60 (21.1) 76.82 (22.1) 66.02 (16.8)
5. CNCEQ-CT 12.09 (4.8) 12.01 (4.8) 12.17 (4.8) 12.17 (5.3) 12.01 (4.4)
6. CNCEQ-OG 12.45 (5.0) 12.90 (5.2) 11.95 (4.8) 11.92 (4.9) 12.90 (5.1)7. CNCEQ-PS 13.22 (5.1) 13.98 (5.3) 12.38 (4.7) 13.39 (5.1) 13.06 (5.0)
8. CNCEQ-SA 12.38 (4.6) 12.59 (5.2) 12.15 (4.0) 12.00 (4.3) 12.71 (5.0)
9. RCADS-(D) 16.71 (4.8) 17.39 (4.9) 15.93 (4.7) 15.98 (4.6) 17.31 (4.8)
10. RCADS-(PD) 13.41 (3.5) 13.22 (3.5) 13.60 (3.7) 13.48 (4.1) 13.34 (3.0)
Note: RCADS = The Revised Child Anxiety and Depression Scales; A = Anxiety; D =
Depression; PA = Parent-Completed Anxiety; PD = Parent-Completed Depression; CASI =
Childhood Anxiety Sensitivity Index; ACQ-C = Anxiety Control Questionnaire for Children;
CNCEQ = Childrens Negative Cognitive Error Questionnaire; CT = Catastrophizing; OG =
Overgeneralizing; PS = Personalizing; SA = Selective Abstraction.a. Significant age group difference.
b. Significant gender difference.
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Table2
Internal
ConsistencyandCorre
lationsAmongtheMea
suresofCognitiveBias
,Anxiety,andDepression
1
2
3
4
5
6
7
8
9
10
1.RCADS-(A)
2.RCADS-(PA
)
.27**
3.CASI
.60**
.07
4.ACQ-C
.37**
.12
.23**
5.CNCEQ-CT
.31**
.04
.24**
.10
6.CNCEQ-OG
.41**
.01
.27**
.24**
.67**
7.CNCEQ-PS
.33**
.09
.32**
.09
.66**
.61**
8.CNCEQ-SA
.35**
.10
.25**
.21*
.66**
.64**
.
64**
9.RCADS-(D)
.73**
.21*
.43**
.29**
.35**
.39**
.
31**
.40**
10.RCADS-(PD
)
.11
.74**
.06
.08
.03
.00
.
09
.07
.19*
Coefficientalpha
.93
.93
.86
.91
.73
.74
.
74
.71
.71
.82
Age6-11(n=75)
.92
.91
.83
.89
.71
.73
.
71
.73
.65
.83
Age12-17(n=
70)
.93
.95
.88
.94
.76
.76
.
77
.67
.77
.82
Note:RCADS=
TheRevisedChildAnxietyandDepressionScales;A
=
Anx
iety;D
=
Depression;PA
=Parent-CompletedAnxiety;PD
=
Parent-
CompletedDepr
ession;CASI=
ChildhoodAnxietySensitivityIndex;ACQ-C
=
AnxietyControlQuestionnaireforChildren;CNCEQ
=C
hildrens
NegativeCognitiveErrorQuestionnaire;CT=
Catastrophizing;OG
=
Overgeneralizing;PS=
Personalizing;
SA
=
SelectiveAbstraction.
*p