Category: ADHD - Child
Children with ADHD have high rates of co-occurring anxiety and depression, making the assessment of internalizing symptoms important for both research and clinical care. In this study we provide the first psychometric evaluation of the Revised Child Anxiety and Depression Scale (RCADS) in children referred for possible ADHD. The RCADS has a number of strengths: it is DSM-based, includes both anxiety and depression in a single measure, has parallel parent- and child-report versions, and is free and available in a number of languages. In addition, the 47-item version assesses depression and specific anxiety dimensions, and a short 25-item version is also available for assessing depression and overall anxiety (RCADS-S). We evaluated both the long and short versions in this study using two independent samples of children (ages 7-12 years) referred for evaluation at an ADHD specialty clinic. Study 1 included 173 parents and children (69% male; Mage=8.64) who each completed the full RCADS. Parents and children both completed other measures of internalizing symptoms, and parents and teachers completed measures of externalizing behaviors. Study 2 included 209 parents and children (67% male; Mage=8.61) who each completed the RCADS-S, and parents also completed the Vanderbilt ADHD Rating Scale (VARS) which includes an internalizing screener. In both studies, the K-SADS diagnostic interview was conducted with the child’s parent. A series of confirmatory factor analyses were conducted to examine the fit of the six-factor RCADS structure (Study 1) and two-factor RCADS-S structure (Study 2). Study 1 results provided strong support for the six-factor structure of the RCADS according to both parent-report (RMSEA=.03, CFI=.96, WRMR=1.05) and child-report (RMSEA=.04, CFI=.94, WRMR=.99). Study 2 results provided moderate support for the parent-report RCADS-S (RMSEA=.07, CFI=.87, WRMR=1.34). The child-report RCADS-S two-factor structure was not supported, with a unidimensional internalizing (anxiety/depression; ie, negative affect) model providing the best fit to the data (RMSEA=.05, CFI=.90, WRMR=1.04). In addition, the RCADS demonstrated convergent validity with other measures of internalizing symptoms, as well as discriminant validity from measures of externalizing behaviors. Finally, in Study 1, parents’ ratings on the RCADS were more strongly associated than their ratings on the VARS internalizing screener with children receiving an internalizing disorder diagnosis on the K-SADS. Overall, this study provides strong support for the RCADS for assessing internalizing symptoms in children with ADHD. While the RCADS-S may be useful when a short measure is needed or appropriate (eg, treatment monitoring), the long version of the RCADS is optimal for both parents and children.
Dana Schindler– Cincinnati Children's Hospital Medical Center
Aaron Luebbe– Associate Professor, Miami University, Oxford, Ohio
Jeffery Epstein– Professor, Cincinnati Children's Hospital Medical Center
Leanne Tamm– Associate Professor, Cincinnati Children's Hospital Medical Center
Stephen Becker– Assistant Professor, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio