Perceptual & Motor Skills: Physical Development & Measurement 2012, 115, 3, 1-22. © Perceptual & Motor Skills 2012

DOI 10.2466/03.10.15.PMS.115.5. ISSN 0031-5125

ASSESSING SEPARATION ANXIETY IN ITALIAN YOUTH: PRELIMINARY PSYCHOMETRIC PROPERTIES OF THE

SEPARATION ANXIETY ASSESSMENT SCALE1

DAPHNE CHESSA

Department of Human Science and Education Perugia University

DANIELA DI RISO, ELISA DELVECCHIO, AND ADRIANA LIS

Department of Developmental Psychology and Socialization University of Padova

Summary.—This study examined the internal consistency and construct valid-ity of the Separation Anxiety Assessment Scale for Children in a non-clinical Italian sample of 358 children ages 6 to 10 years. Statistically significant differences were examined by sex and age. Two exploratory factor analyses were carried out: (a) on the symptom sub-dimensions which led to three interpretable factors of Fear of Abandonment and of Physical Illness, Fear of Calamitous Events, Fear of Being Alone and (b) on all Separation Anxiety Assessment Scale for Children items, which led to three interpretable factors: Fear of Abandonment and Safety Signals, Fear of Calamitous Events, and Fear of Being Alone and Left Alone. Preliminary findings for validity were described with the Separation Anxiety Symptoms Inventory for Children and the Italian Fear Schedule for Children (convergent validity). Implica-tions regarding the clinical utility of the Separation Anxiety Assessment Scale for Children are discussed.

Distress of separation from the caregiver is considered a largely in-nate and universal phenomenon which occurs in humans as well as in other species (Cartwright-Hatton, McNicol, & Doubleday, 2006). Infants typically experience minor and transient forms of separation distress and stranger anxiety that usually fade within the second and third years of life (Menzies, Harris, Cummings, & Einstein, 2000; Eisen & Schaefer, 2007). Separation-related fears begin in the first months of infancy and are part of normal developmental stages. Most such fears tend to be mild and tran-sient and typically persist until 7 or 8 years of age (Eisen & Schaefer, 2007).

Separation anxiety disorder is characterized by an excessive and per-sistent concern and an unrealistic worry about separation from caregivers. Separation anxiety disorder significantly interferes with children’s daily functioning and developmental tasks [American Psychiatric Association (APA), 2000]. Diagnostic symptoms include excessive worries about po-tential injuries to a member of the family, nightmares, and somatic com-

1Address correspondence to D. Chessa, Perugia University, Piazza Ermini 01, 06100 Perugia, Italy or e-mail daphne.chessa@gmail.com

D. Chessa, et al.2

plaints. This disorder is only diagnosed when distress during separation is inappropriate considering the child’s developmental stage (APA, 2000).

Separation anxiety disorder is most common as noted during child-hood (ages 7 to 12 years), with marked declines during mid-adolescence and young adulthood (Last, Perrin, Hersen, & Kazdin, 1996; Compton, Nelson, & March, 2000). Prevalence estimates for anxiety ranges between 2% and 13% for different samples, assessment measures, and informants (Costello & Angold, 1995; Hommersen & Johnston, 2010). Separation anx-iety disorder accounts for about 50% of referrals of children for mental health treatment (Bell-Dolan, 1995; Cartwright-Hatton, et al., 2006). Some 36.1% of cases persist during adolescence and adulthood (Shear, Jin, Rus-cio, Walters, & Kessler, 2006). These findings stress the importance of early intervention. Tests with sound psychometric properties are needed to ac-complish this.

Numerous self-report questionnaires have been constructed and ex-amined to assess anxiety disorders in youth (Hogendoorn, Wolters, Ver-voort, Prins, Boer, & De Haan, 2008; Wood, Sherman, Hamiwka, Black-man, & Wirrell, 2008; Salcuni, Di Riso, Mazzeschi, & Lis, 2009; Ollendick, Raishevich, Davis, Sirbu, & Ost, 2010). The most reliable and common measures are the State-Trait Anxiety Inventory for Children (Spielberg-er, Gorsuch, & Luchene, 1976), the Revised Children’s Manifest Anxiety Scale (Reynolds & Richmond, 1979, 1985), the Fear Survey Schedule for Children–Revised (Ollendick, 1983), the Screen for Child Anxiety Related Emotional Disorders–Revised (Birmaher, Khetarpal, Brent, Cully, Balach, Kaufman, et al., 1997), the Multidimensional Anxiety Scale for Children (March, Parker, Sullivan, & Stallings, 1997), and the Spence Children’s Anxiety Scale (Spence, 1997). Although these measures all possess suit-able psychometric properties and treatment sensitivity, none were de-signed to evaluate symptoms of separation anxiety specifically (Muris, Loxton, Neumann, Du-Plessis, King, & Ollendick, 2006). Recently, there has been interest in specifically assessing separation anxiety in children and young adolescents (Van Dyke, Regan, & Albano, 2009). For example, two tests were developed to diagnose symptoms of separation anxiety, the Separation Anxiety Scale for Children (Mendez, Espada, Orgiles, Hidalgo, & Garcia-Fernandez, 2008) and the Separation Anxiety Symptom Invento-ry for Children (Lis, Raudino, & Chessa, 2008), used for screening.

The Separation Anxiety Assessment Scale for Children (SAAS–C; Ei-sen & Schaefer, 2005) is a 34-item self-report scale that assesses separation anxiety. SAAS–C measures six dimensions of separation anxiety, Fear of Abandonment (5 items), Fear of Being Alone (5 items), Fear of Physical Ill-ness (5 items), Worry about Calamitous Events (5 items), Frequency of Ca-lamitous Events (5 items), and Safety Signal Index (9 items). The first two

Separation anxiety aSSeSSment Scale for children 3

symptom dimensions address the avoidance component of separation anxiety. The third and fourth symptom dimensions capture the mainte-nance component of separation anxiety. Frequency of Calamitous Events was devised to assess to what extent, if any, children’s separation anxiety could be related to actual events. The Safety Signal Index is related to per-sons, places, or objects that help children feel more secure in anxiety-pro-voking situations. The conceptual framework is consistent with DSM–5 Task Force (APA, 2010) change in forms towards examining key symptom dimensions for internalizing and externalizing problems. The importance of the Separation Anxiety Assessment Scale for Children relies on going beyond assessing separation anxiety symptoms to “providing the concep-tual framework that permits individualized case formulations and treat-ment planning” (Eisen, Sussman, Schmidt, Mason, Hausler, & Hashim, 2011; p. 251).

Few studies were published on Separation Anxiety Assessment Scale for Children psychometric properties. Hahn, Hajinlian, Eisen, Winder, and Pincus (2003) assessed children and parents’ perception of separation anxiety disorder dimensions measured on a sample of 139 anxious youth, ages 6 to 17 years. Cronbach’s α coefficients for assessing internal consis-tency responding by both parents and children reports was .68. Validity of the SAAS–C was suggested by moderate to high positive correlations with other measures of childhood anxiety. In more recent studies, scores on items of the Separation Anxiety Assessment Scale for Children, were observed to have significant correlations (.57 to .71) with maternal anxi-ety and perceived parental overprotection in a non-clinical sample of 120 Iranian children (Mofrad, Abdullah, & Abu Samah, 2009; Mofrad, Abdul-lah, Abu Samah, Bte Mansor, & Bte Baba, 2009). Preliminary evidence sup-ports the Separation Anxiety Assessment Scale for Children’s psychomet-ric characteristics. Principal components analysis of Separation Anxiety Assessment Scale for Children items in a sample of 139 anxious youth ages 6 to 17 years reflected two factors: separation anxiety and a fear of physical illness (Hahn, et al., 2003). However, this analysis were carried out only on 20 of the items, excluding the Frequency of Calamitous Events scale and the Safety Signal Index. This choice did not take into account the complex conceptual framework that forms the basis of the scale. Although the published literature is scarce, studies of the scale support its psycho-metric qualities (Hahn, et al., 2003; Einsen, et al., 2011)

The aims of this study were five. First, in examining psychometric properties of the scale in a community sample of Italian youth age 6 to 10 years, expectation was that the total score and scores on the symptom dimensions would be internally consistent. Second, the construct valid-ity of the SAAS–C was evaluated by examining factor structure. A prin-

D. Chessa, et al.4

cipal component analysis should confirm Hahn, et al.’s (2003) two-factor structure. Third, age and sex differences were examined. Because previ-ous studies were estimated for greater prevalence of separation anxiety for girls than for boys (e.g., Spence, 1998; Feigon, Waldman, Levy, & Hay, 2001; Muris, et al., 2006), it was expected that girls would report a high-er measure on separation anxiety symptoms than boys. In prior studies, a lower prevalence has been indicated for adolescents than for children (Muris, et al., 2006; Van Dyke, et al., 2009). Given the specificity of the di-mensions measured, significant mean differences between younger (6 to 7 years) and older children (8 to 10 years) were also expected. Fourth, given a non-clinical sample, it was expected that the mean SAAS–C symptom scores would be statistically significantly lower than those of the Hahn, et al. (2003) sample. The Separation Anxiety Assessment Scale for Chil-dren total score was compared with: (a) scores on the Separation Anxiety Symptoms Inventory for Children (Eisen & Schaefer, 2007), a new brief screening tool for separation anxiety in children, and (b) the Italian Fear Survey Schedule for Children (Di Riso, Salcuni, Chessa, & Lis, 2010), the most “traditional” tool to assess childhood anxiety (Muris, Merckelbach, Ollendick, King, & Bogie, 2002, p. 755). Statistically significant positive correlations were expected for the Separation Anxiety Symptom Inven-tory for Children and the Italian Fear Survey Schedule for Children. Step-wise regression analyses were carried out to examine the links between the Separation Anxiety Assessment Scale for Children total score, the Sep-aration Anxiety Symptom Inventory for Children total and subscales, and the Italian Fear Survey Schedule for Children total score and factors.

Method

ParticipantsIn the sample were 358 children 6 to 10 years of age (M = 9.0; SD = 1.4),

including 183 (51%) girls and 175 (48%) boys recruited from four elemen-tary schools within large and small urban areas in Northern Italy. Partici-pants were Caucasian and attended mainstream classrooms. They came from medium income families (Hollingshead, 1975). Measures

Separation Anxiety Assessment Scale—Child Version (SAAS–C; Eisen & Schaefer, 2005).—The Separation Anxiety Assessment Scale for Children is a 34-item self-report scale for assessment of separation anxiety. The SAAS–C measures six dimensions of separation anxiety, Fear of Abandon-ment (FAb, 5 items), Fear of Being Alone (FBA, 5 items), Fear of Physical Illness (FPI, 5 items), Worry about Calamitous Events (WCE, 5 items), Fre-quency of Calamitous Events (FCE, 5 items), and Safety Signal Index (SSI, 9 items). The first two dimensions address the avoidance component of

Separation anxiety aSSeSSment Scale for children 5

separation anxiety. Fear of Abandonment expresses reluctance or refusal to be “dropped off” specific places like school, an extracurricular activity, or play date unless promised close proximity or complete access to the major attachment figure (e.g., Item 4: “Are you afraid to be left at home with a babysitter?”). Fear of Being Alone expresses reluctance of being alone somewhere in the house such as bedroom, bathroom, or basement (e.g., Item 19: “Do you follow your mom or dad around the house?”). The third and fourth dimensions, i.e., Fear of Physical Illness and Worry about Calamitous Events, capture the maintenance component of separa-tion anxiety. Fear of Physical Illness measures somatic complaints such as headaches, stomachaches, and nausea that typically occur in response to anticipated separations (e.g. Item 27: “Are you afraid to eat lunch at school because you may throw up or choke?”). Worry about Calamitous Events measures worries of catastrophic outcomes possibly occurring to the ma-jor attachment figure, such as being killed in a car accident (e.g., Item 26: “Do you worry that bad things will happen to your parents?”). Frequen-cy of Calamitous Events was devised to assess to what extent, if any, chil-dren’s separation anxiety could be related to actual events (e.g., Item 5: “Has a parent, family member, friend, or relative been in a serious acci-dent?”). The Safety Signal Index is related to persons, places, or objects that help children feel more secure in anxiety-provoking situations (e.g., Item 34: “Do you need a special blanket or toy to help you feel safe when leaving your house?”). Respondents were required to rate their anxiety on a 4-point scale for each item. The scale was scored using a 4-point scale, 1: Never, 2: Sometimes, 3: Most of the time, and 4: All the time. The SAAS–C possesses good internal consistency (α = .91; Hahn, et al., 2003). Most re-cent reviews suggested that preliminary data supported the psychometric properties of the scale (Ehrenreich, Santucci, & Weiner, 2008; Eisen, et al., 2011); however, specific results are still unpublished.

The SAAS–C was not available in Italian. It is clear in the psychomet-ric literature that great care is required when assessing translated items. Many authors draw attention to certain procedures which must be un-dertaken to assure oneself and readers that this has been accomplished (Hambleton, Merenda, & Spielberger, 2005; Merenda, 2006). Cross-cultur-al psychology describes and stresses the importance of backward transla-tion (linguistic equivalence, Peña, 2007) in cultural and language adapta-tions (Merenda, 2006). A back-translation was carried out, following the guidelines developed by the international committee of psychologists of the International Test Commission for back translations (Van de Vijer & Hambleton, 1996). According to these guidelines, the SAAS–C was trans-lated into Italian by a native English speaker and a native Italian speaker separately. These two versions were independently back-translated into

D. Chessa, et al.6

English by two Italian expert scholars in English language and psycholo-gy. Discussion of differences in these four versions resulted in no changes. The Italian version was pilot–tested with 75 children aged 6 to 10 years. Children reported few difficulties in understanding the scale items. No specific problems with item wording emerged.

The translation-adaptation task is complex and requires a combina-tion of techniques (Hambleton, 2001). Classically, the translation process has to ensure linguistic and functional equivalence. Functional equiv-alence assesses that the instructions will elicit the same target behavior (Greenfield, Trumbull, Keller, Rothstein-Fisch, Suzuki, & Quiroz, 2006). The SAAS–C items and instructions were very simple and similar to oth-er measures of anxiety in children of the same age group already translat-ed into Italian (e.g., Spence Children’s Anxiety Scale; Delvecchio, Di Riso, Chessa, & Lis, 2010, and Strength and Difficulties Questionnaire; Di Riso, et al., 2010). In addition to linguistic equivalence and functional equiva-lence, cultural equivalence, and metric equivalence are factors that need to be considered when self-report scales are translated to other languages. Cultural equivalence focuses more centrally on the way the members of different cultural and linguistic groups view and interpret the underlying meaning of an item. The most common assumption in health research ap-pears to be that culture has only a minimal effect on the construct being measured, and therefore the manner in which a construct is defined and operationalized in one culture can be applied directly in another culture (Herdman, Fox-Rushby, & Badia, 1997). According to van Widenfelt, Tref-fers, De Beurs, Siebelink, and Koudijs (2005), descriptive items assessing symptoms were easy to translate. A small pilot sample of 20 children was asked in a brainstorming session to describe the meaning of the Separa-tion Anxiety Assessment Scale for Children items. The meanings attribut-ed by the children were as expected.

Finally, metric equivalence must be achieved, i.e., equivalence in item or question difficulty. The results reported in this paper support metric equivalence of the Italian version. Internal consistency for the SAAS–C to-tal score indexed by Cronbach’s α coefficient was high (α = .89).

Separation Anxiety Symptom Inventory for Children (SASI–C; Chessa, Di Riso, Delvecchio, Lis, & Salcuni, 2012).—The SASI–C is a 15-item child self-report measure of separation anxiety. Respondents were required to rate their anxiety on a 4-point scale: 0: I never had this feeling, 1: This feeling happens occasionally, 2: This feeling happens fairly often, and 3: This feeling happens very often. The scale is now available in Italian and was administered to a sample of 1,397 elementary school children. Inter-nal consistency was (α = .82). Construct analysis by path analysis was per-formed (Chessa, et al., 2012).

The Italian Fear Survey Schedule for Children (FSSC–IT; Di Riso, et al.,

Separation anxiety aSSeSSment Scale for children 7

2010).—The FSSC–IT is an Italian-language version of Ollendick’s Re-vised Fear Survey Schedule for Children (FSSC-R; Ollendick, 1983), a most widely used 80-item fear schedule and measure of general fearfulness. The tool is useful for distinguishing youth with General Anxiety Disorder from youth with Separation Anxiety and/or school refusal behavior (Last, Francis, & Strauss, 1989; Eisen, et al., 2011). The psychometric properties are robust (Gullone, King, Tonge, Heyne, & Ollendick, 2000; Muris & Ol-lendick, 2002; Burnham, 2006). Previous studies reported adequate con-struct and convergent validity, and reliability (Ollendick, 1983; Ollendick, Matson, & Helsel, 1985; Silverman & Nelles, 1988; King, Mulhall, & Gul-lone 1989; King, Ollier, Iacuone, Schuster, Bays, Gullone, et al., 1989; Ol-lendick, King, & Frary, 1989; Spence & Kennedy, 1989; Ollendick, Yule, & Ollier, 1991; Ollendick, Yang, King, Dong, & Akande, 1996). Internal con-sistency reliability was excellent (α = .95) (Ollendick, et al., 1989), as one week test-retest reliability (.80–.89) (Ollendick, 1983; Muris & Ollendick, 2002). Respondents are required to rate their fear on a 3-point scale, 1: None, 2: Some, and 3: Much. Scores are summed to yield a total score. The Italian version was administered to a community sample of 1845 Italian children age 6 to 10 years (Salcuni, et al., 2009; Di Riso, et al., 2010). Princi-pal component analysis with varimax rotation revealed a four-factor so-lution: Death and Danger (21 items, explaining 12.08% of the common variance), Animals and Injury (15 items, 8.45% of the common variance), Failure and Criticism (13 items, 7.00% of the common variance), and Fears of the Unknown (9 items, 5.12% of common variance; Salcuni, et al., 2009). This factor structure revealed the most commonly found factors across children and adolescents in various Western countries (Ollendick, 1983; Ollendick, et al., 1989; Ollendick, et al., 1991; Muris, et al., 2002). The FSSC–IT total score and factors showed good internal consistency: .96 for total score, .92 for Factor 1, α = .87 for Factor 2, α = .85 for Factor 3, and α = .71 for Factor 4. Procedure

Approval by the Human Subjects Committee was obtained for the “separation anxiety in non-clinical school age children” research project, and this current study as a component of the project. The studies were conducted in compliance with the ethical standards for research for the University of Padova, Italy, and with those outlined in the “Ethical Prin-ciples of Psychologists and Code of Conduct 2002” published on-line by the American Psychological Association (2008).

Recruitment.—Participation in this study was solicited from elemen-tary schools, via flyers. The research team contacted the schools to explain the goals of the investigation and ask for their collaboration. Written infor-mation was given to the principals. Four schools kindly agreed to partici-

D. Chessa, et al.8

pate in the study. The population in these schools was of the same socio-economic level as the other schools in the community. Written informed consent was first obtained from the school principals. With the schools’ consent, flyers describing the purpose of the study and confidentiality is-sues were given to students to inform them and their parents about the study. A phone number was listed on the flyers so parents could contact re-searchers for more information. Parents signed informed consent for their children to participate in the study. Children gave their oral consent. Ap-proximately 87% of the families who received the flyer (N = 422) agreed to participate. Those who declined to participated cited reasons such as lack of interest and concerns about sharing personal information. The attrition was comparable to similar studies (Hollman & McNamara, 1999; Muris, Schmidt, Merckelbach, & Schouten, 2001; Spence, Barrett, & Turner, 2003). Exclusion criteria included psychiatric hospitalization and/or psycholog-ical treatment within the past 2 years, or psychological testing within the past year. This information was obtained by asking participants’ parent to complete a short demographic, semi-structured interview after their con-sent for children’s participation. A few participants (n = 8, 2%) met the ex-clusion criteria and were excluded from the study. Once consent from par-ents and children were obtained, experimenters arranged dates and times with teachers for administration of the test.

Data collection.—The 358 children in the community sample complet-ed the Separation Anxiety Assessment Scale for Children, the Separation Anxiety Symptom Inventory for Children and the Italian Fear Survey Schedule for Children during regularly scheduled classes (groups of 20–30). Questionnaires administration were conducted using standardized procedures for the SAAS–C (Hahn, et al., 2003), the SASI–C (Brandibas, Sudres, Gaspard, & Jeunier, 2010), and the IFSS–C (Di Riso, et al., 2010; see Measures section). Children were instructed to refrain from sharing their answers with each other and to be open and honest in their responses. A psychologist, in the presence of their teacher, read the rules and then the items aloud while a teacher and an assistant supervised. In order to avoid bias, researcher were asked not to report the objective of the scale until children had all finished.Statistical Analysis

The Statistical Package for Social Sciences (SPSS, Version 18) was em-ployed for computing means and standard deviations, analyses of vari-ance, exploratory factor analyses (EFA), correlations, and step-wise re-gression. Means and standard deviations were calculated for Separation Anxiety Assessment Scale for Children total and subscale scores, for the entire samples and by sex and age group. Analysis of variance was carried out on the SAAS–C total and subscale scores with sex and age group as be-

Separation anxiety aSSeSSment Scale for children 9

tween-subjects variables. Sex, age group, and sex × age group effects were interpreted when (a) the F ratios were significant, (b) partial eta-square es-timates were substantial (1–5% effect sizes; Cohen, 1992). Exploratory fac-tor analyses were conducted on the SAAS–C items, using principal com-ponents analysis (PCA) as the primary method, with Varimax rotation. Factor solution was chosen based on the number of eigenvalues > 1 and examination of the scree plot. Correlations were performed on SAAS–C total score and (a) another measure of separation anxiety (Separation Anx-iety Symptom Inventory for Children total) and (b) a classic measure of anxiety (Italian Fear Survey Schedule for Children total). Finally, a step-wise regression was carried out to identify which of the independent vari-ables, Separation Anxiety Symptom Inventory for Children or Italian Fear Survey Schedule for Children, explained most variance in Separation Anxiety Assessment Scale for Children total score.

Results

Psychometric PropertiesInternal consistency for the SAAS–C total and subscale scores was

indexed by Cronbach’s α coefficient (.90 for total score). Values for Cron-bach’s αs were acceptable: Fear of Being Alone, α = .69; Fear of Abandon-ment, α = .72; Worry about Calamitous Events, α = .72; Frequency of Ca-lamitous Events, α = .72; Safety Signal Index, α = .70. Cronbach’s α for Fear of Physical Illness was much lower than desirable (α = .54). Most scales had acceptable internal consistency (Nunnally, 1967; for preliminary stud-ies). The only notable exception was the Separation Anxiety Assessment Scale for Children subscale of Fear of Physical Illness; this subscale con-tains only 5 items. In part due to number of items, the total scores pro-

TABLE 1Means, standaRd deviations, skewness, kuRtosis, ConfidenCe inteRvals, and

sepaRation anxiety assessMent sCale foR ChildRen noRMs foR sepaRation anxiety disoRdeR foR total sCoRes and syMptoM diMensions foR total saMple (n = 358)

Scale M SD Skew-ness

Kurtosis 95% CI SAAS–C norms(Eisen & Schaefer,

2007)

SAAS–C Total score 56.98 15.30 0.80 0.66 55.39,58.57 75.0Fear of Being Alone 8.26 3.19 1.23 1.37 7.93,8.59 11.0Fear of Abandonment 6.96 2.77 1.84 3.42 6.67,7.25 12.0Fear of Physical Illness 7.53 2.43 1.21 1.69 7.28,7.78 9.5Worry about Calami-

tous Events 10.19 3.76 0.43 −0.62 9.80,10.58 13.5

Calamitous Events, frequency 9.62 3.55 0.71 −0.02 9.25,9.99 8.0

Safety Signal Index 14.42 4.62 1.19 1.19 13.95,14.89 22.0

D. Chessa, et al.10

duced higher internal consistency estimates than the factor subscale scores (Muris, et al., 2002).

In Table 1, the means, standard deviations, skewness, and kurtosis for SAAS–C subscales are reported. Skewness and kurtosis were calculated as preliminary information. The SAAS–C total score was normally dis-tributed, but scores for most of the subscales were not. Table 1 also reports confidence intervals (p < .05) of the SAAS–C total and subscale scores. For comparison, Table 1 also shows the norms reported for DSM-IV-TR on Separation Anxiety Disorder of SAAS–C total score and subscales (Eisen & Schaefer, 2005). All norms fall outside the interval of confidence of the mean (55.06,59.14). As expected, the current sample of community chil-dren had total scores significantly lower than children diagnosed with Separation Anxiety Disorder.

To examine age differences, children were classified into younger chil-dren (138 children, ages 6 to 7) and older children (220 children, ages 8 to 10) following the Italian school system. Means and standard deviations of

TABLE 2Means, standaRd deviations and analyses of vaRianCe foR sepaRation anxiety

assessMent sCale foR ChildRen total sCoRes, and sepaRation anxiety assessMent sCale foR ChildRen diMensions by age and sex foR the italian saMple (N = 358)

SAAS–C Total score

Fear of Being Alone

Fear of Aban-

donment

Fear of Physical Illness

Worry about Ca-lamitous Events

Calam-itous

Events, frequency

Safety Signal Index

AgeAge 6 to 7

(n = 138)M 58.67 8.80 8.02 10.11 8.98 15.46 6.46SD 16.96 3.50 2.74 3.76 3.32 5.06 5.06

Age 8 to 10 (n = 220)

M 55.92 7.91 7.22 10.23 10.03 13.76 4.76SD 14.10 2.94 2.18 3.77 3.64 4.20 4.20

SexBoys

(n = 175)M 54.60 7.91 6.74 7.18 9.62 9.11 5.02SD 15.68 3.20 2.54 2.27 3.81 3.47 4.69

Girls (n = 183)

M 59.26 8.59 7.15 7.89 10.73 10.12 5.80SD 14.62 3.16 2.97 2.54 3.64 3.56 4.53

Overall sample(N = 358)

M 56.98 8.26 6.96 7.53 10.19 9.62 5.42SD 15.30 3.19 2.77 2.43 3.76 3.55 4.62

Age F(1,354) 2.35 5.98 3.00 9.14 .18 8.91 11.53p .13 .05 .08 .01 .67 .01 .01η2

p .01 .02 .01 .03 .001 .03 .03Sex F(2,354) 5.41 2.68 .87 3.66 5.79 7.28 .96

p .05 .10 .35 .06 .05 .01 .32η2

p .015 .008 .002 .01 .016 .020 .003Age × Sex F(1,354) 2.63 .25 1.29 4.23 2.60 .74 1.66

p .11 .61 .25 .05 .11 .39 .20η2

p .01 .001 .004 .01 .01 .002 .01

Separation anxiety aSSeSSment Scale for children 11

the SAAS–C total and subscales by sex and age subsample are shown in Table 2. A two-factor analysis of variance was performed on the SAAS–C total scores and subscales with sex and age group as between-subjects variables. A summary of analyses is in Table 3.

Girls showed significantly higher separation anxiety (SAAS–C to-tal score) than boys. They scored as more worried than boys on Calami-tous Events and on Calamitous frequency Events. For age-cohort, young-er children scored significantly higher on Fear of Being Alone than older children. They had higher scores on Worried about Physical Illness than older children. Younger children had lower scores on Frequency of Ca-lamitous Events than older children. They reported higher scores on the Safety Signal Index than older children. Mean scores on Fear of Physical Illness (FPI) tended to decrease more rapidly by age group in boys than in girls (Table 4).Construct Validity

Two exploratory factor analyses (EFA) were conducted on the SAAS–

TABLE 3 vaRiMax Rotation faCtoR loadings foR the 20 syMptoMatiC iteMs of

sepaRation anxiety assessMent sCale foR ChildRen (N = 358)

Item F1sy F2sy F3sy h2

SAAS 20 .71 −.19 .11 .55SAAS 25 .71 .11 .22 .56SAAS 4 .70 .11 .02 .50SAAS 12 .54 .17 .15 .34SAAS 8 .51 .15 .20 .32SAAS 33 .50 .02 .21 .30SAAS 7 .45 .13 .44 .41SAAS 2 .41 .22 −.11 .23SAAS 27 .40 .25 .32 .32SAAS 31 .29 .14 .28 .18SAAS 26 .00 .77 .07 .60SAAS 14 .10 .72 .03 .54SAAS 21 .12 .69 .18 .52SAAS 17 .25 .66 −.08 .51SAAS 9 .00 .50 .46 .42SAAS 3 .38 .40 .10 .31SAAS 24 .19 −.10 .71 .54SAAS 13 .20 −.15 .70 .55SAAS 19 .05 .28 .63 .48SAAS 30 .14 .32 .44 .31% variance 16.24 14.57 11.96

Note.—F1sy: Fear of abandonment and of physical illness; F2sy: Worry about calamitous events; F3sy: Fear of being alone.

D. Chessa, et al.12

C items (Floyd & Widaman, 1995; Thompson & Daniel, 1996 Gorsuch, 1997; Fabrigar, Wegener, MacCallum, & Strahan, 1999). Bartlett’s test of sphericity was calculated (Bartlett, 1937; Snedecor & Cochran, 1989). Prin-cipal component analyses (PCA) were conducted as primary method, as in the only previous study with the SAAS–C (Hahn, et al., 2003). The fac-tor solution chosen referred to the number of eigenvalues > 1, examination of the scree plot (Cattell, 1966), parallel analysis criterion (Horn, 1965), and considerations from previous research. A varimax orthogonal rota-tion was used. Loadings greater than or equal to .40 were considered as meaningful. Hahn and colleagues (2003) carried out a principal compo-nent analysis on only 20 symptomatic items, so a first PCA with unity in-serted in the diagonal was conducted on the Pearson correlations among these items to replicate Hahn’s et al. findings (items belonging to FCE and SSI subscales were excluded). The factorability of the correlation matrix was examined by calculating Bartlett’s sphericity [χ²(N = 190) = 1,847.78, p < .0001]. A three-factor structure was identified (Table 4). The analysis ac-counted for 42.78% of the total variance. Factors were identified as: F1sy, Fear of abandonment and of physical illness; F2sy, Worry about calami-

TABLE 4Means, standaRd deviations and analyses of vaRianCe foR sepaRation

anxiety assessMent sCale foR ChildRen foR the 20 syMptoMatiC iteMs pRinCipal CoMponent analysis by age and sex foR an italian saMple (N = 358)

F1sy F2sy F3sy

Age Age 6 to 7 (n = 138)

M 12.18 10.07 7.03SD 3.99 3.92 2.90

Age 8 to 10 (n = 220)

M 10.07 10.33 6.39SD 3.92 4.00 2.49

Sex Boys (n = 175) M 11.09 9.66 6.38SD 3.55 4.00 2.63

Girls (n = 183) M 12.05 10.79 6.89SD 4.16 3.87 2.70

Overall sample (N = 358) M 11.58 10.23 6.64SD 3.90 3.66 2.67

Age F1,354 5.02 0.53 4.32p .05 .46 .05η2

p 0.01 0.00 0.01Sex F2,354 2.76 5.42 2.41

p .10 .05 .12η2

p 0.01 0.02 0.01Age × Sex F1,354 3.54 2.74 .01

p .06 .10 .91η2

p 0.01 0.01 0.00Note.—F1sy: Fear of abandonment and of physical illness; F2sy: Worry about calamitous events; F3sy: Fear of being alone.

Separation anxiety aSSeSSment Scale for children 13

tous events; and F3sy, Fear of being alone. Because the factors were corre-lated a second factor analysis was carried out using a direct Oblimin rota-tion. This rotation resulted in exactly the same factors, loaded by the same items. As a measure of internal consistency reliability, the coefficient al-

TABLE 5Max Rotated faCtoR loadings foR the 34 iteMs of sepaRation

anxiety assessMent sCale foR ChildRen (N = 358)

Item Fsaas1 Fsaas2 Fsaas3 h2

saas28 .67 .08 .09 .46saas33 .65 .01 −.03 .42saas20 .61 −.14 .16 .42saas25 .59 .13 .35 .49saas18 .57 .19 .15 .39saas32 .55 .22 .01 .35saas4 .55 .08 .17 .34saas12 .50 .18 .15 .30saas27 .48 .19 .18 .30saas22 .48 .00 .29 .31saas34 .46 .23 .13 .28saas31 .45 .09 .06 .21saas7 .42 .09 .41 .35saas30 .39 .31 .17 .28saas3 .37 .36 .08 .27saas2 .26 .16 .19 .13saas1 .26 .08 .19 .11saas26 .05 .79 .04 .63saas29 .19 .68 .06 .52saas14 .09 .69 .09 .50saas11 .03 .66 −.01 .43saas21 .13 .64 .20 .47saas17 .21 .61 −.02 .42saas16 .20 .60 .20 .44saas23 .23 .54 −.17 .38saas5 −.06 .51 .51 .53saas6 .10 .40 .23 .23saas10 .09 .12 .69 .50saas24 .22 −.11 .64 .47saas15 .29 .08 .60 .45saas13 .29 −.13 .60 .46saas19 .12 .24 .54 .36saas9 −.01 .46 .51 .47saas8 .30 .15 .44 .31% variance 14.01 13.99 10.00

Note.—Fsaas1: Fear of abandonment and need to be supported by safety people or objects; Fsaas2: Fear of calamitous events; Fsaas3: Fear to be alone and left alone.

D. Chessa, et al.14

phas based on the items that loaded > .40 on each of the three factors were calculated. Cronbach’s αs were good (α = .75 for F1sy, α = .72 for F2sy, and α = .62 for F3sy). Factors scores were calculated as sum scores on the vari-ables loading saliently on each of the three factors.

Analysis of variance (ANOVA) was carried out on the three factors identified (F1sy, Fear of abandonment and of physical illness; F2sy, Worry about calamitous events; F3sy, Fear of being alone) by the symptomatic subscales with sex and age-groups as between-subject variables. Means and standard deviations of three factors by sex and age group are shown in Table 3. The results of the ANOVA also are summarized in Table 3. Girls showed significantly higher Fears of calamitous events than boys. Young-er children showed significantly higher fear of being abandoned and of physical illness, and of being alone than older children.

The second PCA was carried out on the SAAS–C with all 34 items. The aim of the second analysis was to examine how the Safety Signal In-dex and Frequency of Calamitous Events would influence and/or interact with symptomatic items. The factorability of the correlation matrix was examined by calculating Bartlett’s test of sphericity [χ²(N = 561) = 4,074.72,

TABLE 6Means, standaRd deviations, and analyses of vaRianCe foR sepaRation

anxiety assessMent sCale foR ChildRen foR the 34 iteMs pRinCipal CoMponent analysis by age and sex foR an italian saMple (N = 358)

Fsaast1 Fsaast2 Fsaast3

Age Age 6 to 7 (n = 138)

M 19.38 18.25 15.89SD 6.80 6.49 5.87

Age 8 to 10 (n = 220)

M 17.40 19.88 15.24SD 6.07 7.01 5.37

Sex Boys (n = 175) M 17.69 18.38 12.71SD 5.65 6.80 5.50

Girls (n = 183) M 18.63 20.37 16.24SD 6.42 6.75 5.16

Overall sample (N = 358) M 18.17 19.40 15.49SD 6.07 6.84 5.37

Age F1,354 8.78 3.51 .97p .01 .06 .33η2

p 0.02 0.01 0.00Sex F2,354 .91 6.40 4.99

p .34 .05 .05η2

p 0.00 0.02 0.01Age × Sex F1,354 1.03 1.93 1.95

p .31 .17 .16η2

p 0.00 0.01 0.01Note.—Fsaas1: Fear of abandonment and need to be supported by safety people or objects; Fsaas2: Fear of calamitous events; Fsaas3: Fear to be alone and left alone.

Separation anxiety aSSeSSment Scale for children 15

p < .0001]. A three-factor structure was identified (Table 5), accounting for 40.00% of the total variance.

Factors were identified as: Fsaas1, Fear of abandonment and need to be supported by safety people or objects; Fsaas2, Fear of calamitous events; Fsaas3, Fear to be alone and left alone. Because the factors were correlated, a second factor analysis was carried out using a direct Oblim-in rotation. This rotation resulted in the same factors loaded by the same items. As a measure of internal consistency reliability, the coefficient al-phas based on the items that loaded > .40 on each of the three factors were calculated; Cronbach’s alphas were Fsaas1 α = .83, Fsaas2 α = .85, Fsaas3 α = .77. Factors scores were calculated as sum scores on the variables load-ing > .40 on each of the three factors. A two factors ANOVA was carried on the three factors of the 34-item SAAS–C with sex and age groups as be-tween-subjects variables. Means and standard deviations of the three fac-tors by sex and age group are shown in Table 6. The results of the ANOVA for the factors obtained in the factor analysis are summarized in Table 4. Girls showed significantly higher scores than boys on Fear of calamitous events and Fear to be alone and left alone. Younger children showed sig-nificantly higher Fear of abandonment and need to be supported by safety people or objects. Convergent Validity

Correlations between the Separation Anxiety Symptom Inventory for Children total score, the Italian Fear Survey Schedule for Children total score, and SAAS–C factors and total score and subscales are shown in Ta-ble 7.

The correlations were all significant (p < .001) and effect size (Cohen, 1988) between the Separation Anxiety Symptom Inventory for Children total score and the SAAS–C total score was large. However, the correlation between the scales (r = .54) showed only partial overlap between the two scales. Correlation between the SAAS–C C original subscales and factors yielded by the EFA with the SASI–C total score were all moderate (r > .31). However, correlations of SAAS–C factors with IFSS-C total score and fac-tors were mostly low to medium effects. These results indicate that IFSS-C appears to measure a somewhat different aspect of anxiety (i.e., specific fears or phobias).

A stepwise multiple regression analysis was performed with the SASI–C total score and IFSS-C total score as predictor variables and the SAAS–C total score as criterion variable, to identify which of the two in-dependent variables was most likely to contribute to the SAAS–C total score (Table 8).

The SASI–C total score and the IFSS-C total score accounted for 36.2% of variance in the SAAS–C total score. The SASI–C total score accounted

D. Chessa, et al.16

for 28.7% and the IFSS-C total score added only 7.5% of variance, and was excluded by the stepwise model. The highest beta coefficient was for the SASI–C. These findings preliminarily supported the convergent validity of the SAAS–C as a measure for separation anxiety rather than a measure of fears. According to literature, higher scores on IFSS-C are a precursor to more severe mental health issues such as anxiety disorders or phobic disorders (La Greca & Harrison, 2005; Muris, 2007; Muris, Merckelbach, Mayer, & Prins, 2000). The medium effect sizes between the SAAS–C total score and IFSS-C total score and the low variance explained by the latter (7.5%), seem to support this hypothesis and to support discriminant va-lidity of the SAAS–C.

disCussionMany authors (Ehrenreich, et al., 2008; Eisen, et al., 2011) stress the im-

TABLE 8stepwise RegRession analysis on sepaRation anxiety

assessMent sCale foR ChildRen oR total sCoRe

B 95%CI B SE B β p

SASI–C Total score .68 0.71, 1.03 .09 .40 <.001FSSC–IT Total score .16 0.12, 0.22 .03 .30 .01Note: R2 = .362; ΔR2 = .075 (p < .001).

TABLE 7peaRson CoRRelations between sepaRation anxiety assessMent sCale foR ChildRen total

sCoRe, sepaRation anxiety assessMent sCale foR ChildRen syMptoM diMensions and faCtoRs; sepaRation anxiety syMptoM inventoRy foR ChildRen total sCoRe, italian feaR suRvey sChed-

ule foR ChildRen total sCoRe and faCtoRs on the total saMple (N = 358)

SASI TOT

FSSC–IT Total

score

Death and

Danger

Injury and

Animals

Failure and Criti-

cism

Fear of the Un-known

SAAS–C Total .54 .51 .42 .49 .42 .35Fear of Being Alone .39 .42 .36 .43 .30 .26Fear of Abandonment .33 .39 .19 .38 .38 .53Fear of Physical Illness .33 .40 .30 .38 .39 .29Worry about Calamitous Events .41 .42 .47 .37 .30 .09 (ns)Calamitous Events, frequency .46 .38 .38 .31 .30 .15Safety Signal Index .42 .33 .20 .34 .28 .22F1sy .38 .45 .25 .44 .44 .54F2sy .40 .41 .46 .36 .29 .08 (ns)F3sy .38 .37 .33 .37 .33 .18Fsaast1 .38 .40 .22 .41 .22 .47Fsaast2 .45 .41 .43 .33 .43 .10Fsaast3 .45 .42 .38 .40 .38 .30*p < .01.

Separation anxiety aSSeSSment Scale for children 17

portance of the Separation Anxiety Assessment Scale for Children (SAAS–C) as a specific measure for separation anxiety disorder in children and ad-olescents. Studies of its psychometric characteristics are scarce. Moreover, since this measure was originally established in English, there is a need to adapt it for use in other countries. This study investigated preliminarily the adaptation of the SAAS–C to the Italian population. The translation and ad-aptation task is complex and requires a combination of techniques (Ham-bleton, 2001). The present study first tried to establish a sufficient quality of translation and reported the process to develop methodological norms, ap-propriate statistical procedures, and draw conclusion about the construct assessed (van Widenfelt, et al., 2005; Peña, 2007). The original authors were contacted and asked for permission for translation. They agreed on the im-portance of the translation and adaptation process.

The results provided support for internal consistency of the SAAS–C and its subscales. Preliminary results supported construct and conver-gent validity as well. The findings confirmed previous studies reporting higher prevalence of anxiety symptoms in girls than boys (Feigon, et al., 2001; Muris, et al., 2006). Although no significant differences were found between younger and older children regarding the SAAS–C total scores, differences were observed on four of the six subscales. These differences provide preliminary support for the sensitivity of the SAAS–C subscales for detecting age-related separation symptoms.

Unlike the Hahn, et al., (2003) investigation, principal component analysis demonstrated a three-factor structure. Studies in both clinical and non-clinical samples are needed to confirm or disconfirm the SAAS–C’s factor structure.

Studies need to be carried out to explore the contribution of other dimensions in explaining separation anxiety construct. Moreover, the SAAS–C’s relationship with other variables such as individual personal-ity differences, environmental and familiar influences, first attachment re-lationship, and parental psychopathology should be also explored.

In conclusion, further work is warranted on the factor structure of the Separation Anxiety Assessment Scale for Children using clinical and non-clinical samples across different age groups and cultures. Participants consisted only of Caucasian non-clinical children of medium socio-eco-nomic status. In contrast with other studies, 50 to 75% of children with a diagnosis of separation anxiety came from lower socio-economic level families with low income status (Masi, Mucci, & Millepiedi, 2001; Shear, et al., 2006). Confirmatory factor analyses need to be carried out with larger samples. Future studies need also to examine more extensively the SAAS–C across a range of internalizing and externalizing disorders in both non-clinical and clinical populations.

D. Chessa, et al.18

The importance of assessing separation anxiety in children cannot be overstated. Longitudinal studies have emphasized that a first diagnosis of Separation Anxiety Disorder during childhood represents a risk factor for adolescence or adulthood anxiety disorders (Masi, et al., 2001). Future re-search is needed to detect if Separation Anxiety Disorder is a general vul-nerability for a broad range of anxiety disorders or, specifically, for agora-phobia or panic disorder in adulthood (Silove, Manicavasagar, Curtis, & Blaszczynski, 1996; Manicavasagar, Silove, Curtis, & Wagner, 2000).

The Separation Anxiety Assessment Scale for Children’s specificity should help clinicians and researchers in highlighting a cut off for Chil-dren at risk of psychopathology. The Separation Anxiety Assessment Scale for Children could be administered in community samples to high-light potential difficulties in the separation anxiety domain. This could facilitate the development of prevention programs or, if severe disorders would be detected, a plan for individualized case formulation and treat-ment (see Eisen & Schaefer, 2005).

REFERENCESaMeRiCan psyChiatRiC assoCiation. (2000) DSM-IV–TR. Diagnostic and statistical manual of

mental disorders. (4th ed.) Washington, DC: Author.aMeRiCan psyChologiCal assoCiation. (2008) Ethical principles of psychologists and

code of conduct Retrieved February 7, from http://www.apa.org/ethics/.aMeRiCan psyChiatRiC assoCiation. (2010) DSM 5: diagnostic and statistical manual of men-

tal disorders—Task Force. Washington, DC: Author.baRtlett, M. s. (1937). Properties of sufficiency and statistical tests. Proceedings of the Royal

Statistical Society, Series A, 160, 268-282.bell-dolan, d. J. (1995) Social cue interpretation of anxious children. Journal of Clinical

Child Psychology, 24, 2-10.biRMaheR, b., khetaRpal, s., bRent, d., Cully, M., balaCh, l., kaufMan, J., & MCkenzie neeR,

s. (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, 545-553.

bRandibas, g., sudRes, J. l., gaspaRd, J. l., & JeunieR, b. (2010) Evaluer l’anxiété de sépa-ration de l’adolescent avec le Separation Anxiety Symptom Inventory (SASI) ad-aptation et validation française. Neuropsychiatrie de l’Enfance et de l’Adolescence, 58, 480-187.

buRnhaM, J. J. (2006) Comparing children’s fears in Alabama: an investigation using post-9/11 and post-invasion into Iraq data. The Alabama Counseling Association Jour-nal, 32, 32-42.

CaRtwRight-hatton, s., MCniCol, k., & doubleday, e. (2006) Anxiety in a neglected population: prevalence of anxiety disorders in pre-adolescent children. Clinical Psy-chological Review, 26, 817-833.

Cattell, R. b. (1966) The scree test for the number of factors. Multivariate Behavioral Re-search,1, 245-276.

Chessa, d., di Riso, d., delveCChio, e., lis, a., & salCuni, s. (2012) Antecedents and mod-erators of anxiety disorders in a community sample of Italian children aged eight to

Separation anxiety aSSeSSment Scale for children 19

ten years old. In S. A. Lee & D. M. Edget (Ed.), Cognitive behavioral therapy: applica-tions, methods, and outcomes. Hauppauge, NY: Nova Science. Pp. 115-134.

Cohen, J. (1988) Statistical power analysis for the behavioral sciences. (2nd ed.) Hillsdale, NJ: Erlbaum.

Cohen, J (1992) A power primer. Psychological Bulletin, 112(1), 155-159. CoMpton, s. n., nelson, a. h., & MaRCh, J. s. (2000) Social phobia and separation anxi-

ety symptoms in community and clinical samples of children and adolescents. Jour-nal of the American Academy of Child and Adolescent Psychiatry, 39, 1040-1046.

Costello, e. J., & angold, a. (1995) Epidemiology. In J. S. March (Ed.), Anxiety disorders in children and adolescents. New York: Guilford. Pp. 109-124.

delveCChio, e., di Riso, d., Chessa, d., & lis, a. (2010) The Spence Children’s Anxiety Scale in Italian children aged 8–10. Bollettino di Psicologia Applicata, 261/262, 117-122.

di Riso, d., salCuni, s., Chessa, d., & lis, a. (2010) The Fear Survey Schedule for Chil-dren–Revised: normative developmental data in Italy. Perceptual and Motor Skills, 110, 625-646.

ehRenReiCh, J. t., santuCCi, l. C., & weineR, C. (2008) Separation anxiety disorder in youth: phenomenology, assessment and treatment. Psicología Conductual, 16(3), 389-412.

eisen, a. R., & sChaefeR, C. e. (2005) Separation anxiety in children and adolescents: an indi-vidualized approach to assessment and treatment. New York: Guilford.

eisen, a. R., & sChaefeR, C. e. (2007) Separation anxiety in children and adolescents: an indi-vidualized approach to assessment and treatment. New York: Guilford.

eisen, a. R., sussMan, J. M., sChMidt, t., Mason, l., hausleR, l. a., & hashiM, R. (2011) Sep-aration anxiety disorder. In D. McKay & E. A. Storch (Ed.), Handbook of Child and Adolescent Anxiety Disorders, Part 4. New York: Springer. Pp. 245-259.

fabRigaR, l. R., wegeneR, d. t., MaCCalluM, R. C., & stRahan, e. J. (1999) Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods, 4, 272-299.

feigon, s. a., waldMan, i. d., levy, f., & hay, d. a. (2001) Genetic and environmental influences on separation anxiety disorder symptoms and their moderation by age and sex. Behavior Genetics, 31, 403-411.

floyd, f. J., & widaMan, k. f. (1995) Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment, 7, 286-299.

goRsuCh, R. l. (1997) Exploratory factor analysis: its role in item analysis. Journal of Personality Assessment, 68, 3, 532-560.

gReenfield, p. M., tRuMbull, e., kelleR, h., Rothstein-fisCh, C., suzuki, l., & QuiRoz, b. (2006) Cultural conceptions of learning and development. In P. Alexander & P. H. Winne (Eds.), Handbook of educational psychology. (2nd ed.) Mahwah, NJ: Erlbaum. Pp. 675-692.

gullone, e., king, n. J., tonge, b. J., heyne, d., & ollendiCk, t. h. (2000) The Fear Sur-vey Schedule for Children–II (FSSC–II): validity data as a treatment outcome mea-sure. Australian Psychologist, 35, 238-243.

hahn, l., haJinlian, J., eisen, a. R., windeR, b., & pinCus, d. b. (2003) Measuring the dimensions of separation anxiety and early panic in children and adolescents: the Separation Anxiety Assessment Scale. In A. R. Eisen (Ed.), Recent advances in the treatment of separation anxiety and panic in children and adolescents. Paper presented at the 37th annual convention of the Association for the Advancement of Behavior Therapy, Boston, MA.

D. Chessa, et al.20

haMbleton, R. k. (2001) The next generation of the ITC test translation and adaptation guidelines. European Journal of Psychological Assessment, 17(3), 164-172.

haMbleton, R. k., MeRenda, p. f., & spielbeRgeR, C. d. (2005) Adapting educational and psychological tests for cross-cultural assessment. Mahwah, NJ: Erlbaum.

heRdMan, M., fox-Rushby, J., & badia, x. (1997) “Equivalence” and the translation and adaptation of health-related quality of life questionnaires. Quality of Life Research, 6, 237-247.

hogendooRn, s. M., wolteRs, l. h., veRvooRt, l., pRins, p. J., boeR, f., & de haan, e. (2008) An indirect and direct measure of anxiety-related perceived control in chil-dren: the Implicit Association Procedure (IAP) and Anxiety Control Questionnaire for Children (ACQ C). Journal of Behaviour Therapy and Experimental Psychiatry, 39, 436-450.

hollingshead, a. b. (1975) Four factor index of social status. Unpublished working pa-per. New Haven, CT: Yale Univer. Press.

hollMann, C. M., & MCnaMaRa, J. R. (1999) Considerations in the use of active and pas-sive parental consent procedures. The Journal of Psychology, 133, 141-156.

hoMMeRsen, p., & Johnston, C. (2010) Separation anxiety and oppositional defiant be-havior: perceived comorbidity resulting from ambiguous behavioral items. Journal of Psychopathology and Behavioral Assessment, 32, 96-107.

hoRn, J. l. (1965) Fluid and crystallized intelligence: a factor analytic study of the struc-ture among primary mental abilities. Unpublished Ph.D. thesis, Univer. of Illinois.

king, n. J., Mulhall, J., & gullone, e. (1989) Fears in hearing-impaired and normally hearing children and adolescents. Behaviour Research and Therapy, 27(5), 577-580.

king, n. J., ollieR, R., iaCuone, s., sChusteR, s., bays, k., gullone, e., & ollendiCk, t. h. (1989) Fears of children and adolescents: a cross-sectional Australian study using the revised fear survey schedule for Children. Journal of Child Psychology and Psy-chiatry, 30, 775-784.

la gReCa, a. M., & haRRison, h. w. (2005) Adolescent peer relations, friendships, and romantic relationships: do they predict social anxiety and depression? Journal of Clinical Child and Adolescent Psychology, 34, 49-61.

last, C. g., fRanCis, g., & stRauss, C. C. (1989) Assessing fears in anxiety-disordered children with the Revised Fear Survey Schedule for Children (FSSC–R). Journal of Clinical Child Psychology, 18, 137-141.

last, C. g., peRRin, s., heRsen, M., & kazdin, a. e. (1996) A prospective study of child-hood anxiety disorders. Journal of the American Academy of Child and Adolescent Psy-chiatry, 35, 1502-1510.

lis, a., Raudino, a., & Chessa, d. (2008) Ansia di separazione: la validazione italiana del SASI–C. Paper presented at Seconda Giornata aostana dei contributi dei giovani ricer-catori di Psicologia Dinamica, Clinica e Sociale 2nd, Aosta, Italy, May 23–24.

ManiCavasagaR, v., silove, d., CuRtis, J., & wagneR, R. (2000) Continuation of separation anxiety from early life into adulthood. Journal of Anxiety Disorders, 14, 1-18.

MaRCh, J. s., paRkeR, J. d., sullivan, a., & stallings, k. p. (1997) The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 554-565.

Masi, g., MuCCi, M., & Millepiedi, s. (2001) Separation anxiety disorder in children and adolescents: epidemiology, diagnosis, and management. CNS Drugs, 15, 93-104.

Mendez, x., espada, J. p., oRgiles, M., hidalgo, M. d., & gaRCia-feRnandez, J. M. (2008) Psychometric properties and diagnostic ability of the Separation Anxiety Scale for Children (SASC). European Child & Adolescent Psychiatry, 17, 365-372.

Separation anxiety aSSeSSment Scale for children 21

Menzies, R. g., haRRis, l., CuMMings, s., & einstein, d. a. (2000) The relationship be-tween inflated personal responsibility and exaggerated danger expectancies in ob-sessive compulsive concerns. Behaviour Research and Therapy, 38, 1029-1037.

MeRenda, p. f. (2006) An overview of adapting educational and psychological assess-ment instruments: past and present. Psychological Reports, 99, 307-314.

MofRad, s., abdullah, R., & abu saMah, b. (2009) Perceived parental overprotection and separation anxiety: does specific parental rearing serve as specific risk factor? Asian Social Science, 5, 109-116.

MofRad, s., abdullah, R., abu saMah, b., bte MansoR, M., & bte baba, M. (2009) Ma-ternal psychological distress and separation anxiety disorder in children. European Journal of Social Sciences, 8, 386-394.

MuRis, p. (2007) Normal and abnormal fear and anxiety in children and adolescents. Oxford, UK: Elsevier.

MuRis, p., MeRCkelbaCh, h., MayeR, b., & pRins, e. (2000) How serious are common child-hood fears? Behaviour Research and Therapy, 38, 217-228.

MuRis, p. l., loxton, h., neuMann, h., du-plessis, a., king, M. n., & ollendiCk, t. h. (2006) DSM-defined anxiety disorders symptoms in South African youths: their assessment and relationship with perceived parental rearing behaviors. Behaviour Research and Therapy, 44, 883-896.

MuRis, p. l., MeRCkelbaCh, h., ollendiCk, t. h., king, M. 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, 753-772.

MuRis, p. l., & ollendiCk, t. h. (2002) The assessment of contemporary fears in adoles-cence using a modified version of the Fear Survey Schedule for Children Revised. Journal of Anxiety Disorders, 16, 563-584.

MuRis, p., sChMidt, h., MeRCkelbaCh, h., & sChouten, e. (2001) Anxiety sensitivity in adolescents: factor structure and relationships to trait anxiety, and symptoms of anxiety disorders and depression. Behaviour Research and Therapy, 39, 89-100.

NuNNally, •. (1967) AUTHOR: PleAse Add RefeRence.ollendiCk, t. h. (1983) Reliability and validity of the Revised Fear Survey Schedule for

Children (FSSC–R). Behaviour Research and Therapy, 21, 685-692. ollendiCk, t. h., king, n. J., & fRaRy, R. b. (1989) Fears in children and adolescents:

reliability and generalizability across gender, age and nationality. Behavior Research and Therapy, 27(1), 19-26.

ollendiCk, t. h., Matson, J. l., & helsel, w. J. (1985) Fears in children and adolescents: normative data. Behaviour Research and Therapy, 23(4), 465-467.

ollendiCk, t. h., RaisheviCh, n., davis, t. e., iii, siRbu, C., & ost, l. g. (2010) Specific phobia in youth: phenomenology and psychological characteristics. Behavior Ther-apy, 41, 133-141.

ollendiCk, t. h., yang, b., king, n. J. dong, Q., & akande, a. (1996) Fears in American, Australian, Chinese, and Nigerian children and adolescents: a cross-cultural study. Journal of Child Psychology and Psychiatry, 37, 213-220.

ollendiCk, t. h., yule, w., & ollieR, k. (1991) Fears in British children and their rela-tionship to manifest anxiety and depression. Journal of Child Psychology and Psychia-try, 32, 321-331.

peña, e. d. (2007) Lost in translation: methodological considerations in cross-cultural research. Child Development, 78(4), 1255-1264.

D. Chessa, et al.22

Reynolds, C. R., & RiChMond, b. o. (1979) Factor structure and construct validity of “What I Think and Feel”: the Revised Children’s Manifest Anxiety Scale. Journal of Personality Assessment, 43, 281-283.

Reynolds, C. R., & RiChMond, b. o (1985) Revised Children’s Manifest Anxiety Scale. Los Angeles: Western Psychological Service.

salCuni, s., di Riso, d., MazzesChi, C., & lis, a. (2009) Children’s fears: a survey of Ital-ian children ages 6 to 10 years. Psychological Reports, 104, 971-988.

sheaR, k., Jin, R., RusCio, a. M., walteRs, e. e., & kessleR, R. C. (2006) Prevalence and correlates of estimated DSM–IV Child and Adult Separation Anxiety Disorder in the National Comorbidity Survey: replication. The American Journal of Psychiatry, 163, 1074-1083.

silove, d., ManiCavasagaR, v., CuRtis, J., & blaszCzynski, a. (1996) Is early separation anxiety a risk factor for adult panic disorder? A critical review. Comprehensive Psy-chiatry, 37, 167-179.

silveRMan, w. k., & nelles, w. b. (1988) The Anxiety Disorders Interview Schedule for Children. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 6, 772-8.

snedeCoR, g. w., & CoChRan, w. g. (1989) Statistical methods. 8th ed. Iowa City, IA: Univ-er. of Iowa Press.

spenCe, s. h. (1997) Structure of anxiety symptoms among children: a confirmatory factor-analytic study. Journal of Abnormal Psychology, 106, 280–297.

spenCe, s. h. (1998) A measure of anxiety symptoms among children. Behavior Research and Therapy, 36, 545–566.

spenCe, s. h., baRRett, p. M., & tuRneR, C. M. (2003) Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. Journal of Anxiety Disor-ders, 17, 6, 605-625.

spenCe, h., & kennedy, e. (1989) Australian data for the Children’s Action Tendency Scale, the Children’s Depression Inventory and Fear Survey Schedule for Children-revised. The Australian Educational & Developmental Psychologist, 6, 16-21.

spielbeRgeR, C. d., goRsuCh, R., & luChene, R. (1976) Manual for the State Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.

thoMpson, b., & daniel, l. g. (1996) Factor analytic evidence for the construct validity of scores: An historical overview and some guidelines. Educational and Psychological Measurement, 56, 213–224.

van de viJveR, f., & haMbleton, R. k. (1996) Translating tests: some practical guide lines. European Psychologist, 1, 89-99.

van dyke, C. J., Regan, J., & albano, a. M. (2009) Separation anxiety disorder. In D. McKay & E. A. Storch (Eds.), Cognitive-behavior therapy for children: treating complex and refractory cases. New York: Springer. Pp. 115-140.

van widenfelt, b. M., tReffeRs, p. d., de beuRs, e., siebelink, b. M., & koudiJs, e. (2005) Translation and cross-cultural adaptation of assessment instruments used in psy-chological research with children and families. Clinical child and family psychology review, 8(2), 135-147.

wood, l. J., sheRMan, e., haMiwka, l. d., blaCkMan, M., & wiRRell, e. (2008) Depres-sion, anxiety, and quality of life in siblings of children with intractable epilepsy. Epilepsy and Behavior, 13, 144-148.

Accepted October 31, 2012.