Preschool Anxiety Scale (PAS)

The Preschool Anxiety Scale (PAS) is a 28 item scale that is completed by a parent / guardian and which assesses anxiety in children between the ages of 2 ½ and 6 ½ years old. The 28 anxiety items provide an overall measure of anxiety, in addition to scores on five subscales assessing a specific aspect of child anxiety:

  1. Generalised anxiety
  2. Social anxiety
  3. Obsessive compulsive disorder
  4. Physical injury fears
  5. Separation anxiety

The PAS is intended to provide an indicator of the number and severity of anxiety symptoms experienced by younger children (Spence et al., 2001). It is not designed to be a diagnostic instrument for use in isolation although it provides important information to inform the assessment process. Where a clinical diagnosis is required the PAS should be used as an adjunct to clinical interview. It may also be used for identification of young children who have elevated symptoms of anxiety and for whom further assessment is recommended to determine whether there is a need for intervention. Similarly, it provides an indicator of response to treatment. It can also be used to identify children for whom early intervention or prevention is warranted on the basis of elevated anxiety symptoms being a risk factor for the development of future emotional and mental health problems.

Psychometric Properties

The scale was initially developed through extensive review of the literature relating to preschool anxiety problems, use of diagnostic criteria, structured clinical interviews, existing measures of childhood anxiety, and input from the authors, all of whom have extensive experience in research and clinical practice relating to preschool anxiety problems (Spence et al., 2001). Several questions were drawn from the Spence Children’s Anxiety Scale (Spence, 1997, 1998), but reworded for preschool situations. Pilot versions of the questionnaire were then completed by groups of parents of preschoolers, who provided feedback about the relevance and understandability of the items and the questionnaire was then piloted with a sample of 600 parents of children aged between 3 and 5 years. 

Factor analysis from the pilot data resulted in a five factor model for anxiety, reflecting dimensions of social phobia, separation anxiety, obsessive compulsive disorder, fears of physical injury, and generalised anxiety (Spence et al., 2001). The five factors were strongly inter-correlated and this strong covariance was well explained by a single, higher-order factor of anxiety in general. Although the five first-order factors loaded strongly upon the higher-order anxiety factor, there was sufficient unique variance (between 40 and 60%) explained by three of the first order factors (social anxiety, obsessive compulsive disorder and fears of physical injury) to justify regarding them as dimensions worthy of independent consideration. The picture was less clear for separation anxiety and generalized anxiety, as these dimensions accounted for only a small percent of unique variance in mothers’ ratings of preschooler anxiety symptoms (12 and 19%, respectively). No significant differences were found between boys and girls in a large sample of 3- to 5-year olds for the total symptom ratings or any of the factor scores (Spence et al., 2001).

Construct validity was moderate with a significant correlation between PAS total score and the CBCL Internalizing total score (r = 0.68). Each PAS subscale also correlated significantly with the CBCL Internalizing total score (GAD, r = 0.60; Social Anxiety r = 0.57; Separation Anxiety r = 0.50; OCD r = 0.42; and Physical Injury Fears r = 0.43). The total scale and subscales showed strong internal consistency (alphas = .72–.92), 12-month stability (r = .60–.75) and maternal/paternal agreement (rs = .60–.75; Edwards et al., 2010). Scores on the scale also showed expected correlations with a measure of emotional distress, diagnosed anxiety disorders, and behavioral indicators of anxiety (Edwards et al., 2010).

Scoring and Interpretation 

Each item is rated on a 5-point scale from 0 ‘not at all’ to 4 ‘very often true’. Question 29 is an open-ended, non-scored item relating to the child’s experience of a traumatic event. This is followed by 5 items relating to whether the child exhibits behaviour indicative of post-traumatic stress reactions following the trauma. These items are not included in the scoring and are for clinical interest only.

The subscale scores are computed by adding the individual item scores on the set of items as follows:

  • Generalised Anxiety (sum of items 1, 4, 8, 14, 28)
  • Social Anxiety (sum of items 2, 5, 11, 15, 19, 23)
  • Obsessive Compulsive Disorder (sum of items 3, 9, 18, 21, 27)
  • Physical Injury Fears (sum of items 7, 10, 13, 17, 20, 24, 26)
  • Separation Anxiety (sum of items 6, 12, 16, 22, 25)
  • Total Score (sum of items 1-28)

Parents may report elevated scores on the PAS in two ways: in terms of elevated total scores and high scores on one or more subscale scores. Although the majority of children who show a high total score also show a high score on one or more subscales, this is not always the case. Thus, for clinical assessments, we recommend examining the total and subscale scores. For screening purposes in community samples, it may be sufficient to use the total score for identification of children at risk.

Normative percentiles were obtained from a community sample (Spence et al., 2001), indicating how the respondent scored in relation to a typical pattern of responding for children. For example, a percentile of 50 indicates the child has average levels of anxiety when compared to non-clinical preschool aged children

Developer

Spence, S. H., Rapee, R., McDonald, C., & Ingram, M. (2001). The structure of anxiety symptoms among preschoolers. Behaviour Research and Therapy, 39(11), 1293–1316. https://doi.org/10.1016/s0005-7967(00)00098-x

References

Edwards, S. L., Rapee, R. M., Kennedy, S. J., & Spence, S. H. (2010). The assessment of anxiety symptoms in preschool-aged children: the revised Preschool Anxiety Scale. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 39(3), 400–409. https://doi.org/10.1080/15374411003691701

Spence, S. H. (1997). The structure of anxiety symptoms among children: A confirmatory factor analytic study. Journal of Abnormal Psychology, 106, 280297. https://doi.org/10.1037//0021-843x.106.2.280 

Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545566. https://doi.org/10.1016/S0005-7967(98)00034-5