INTERNALISING BEHAVIOURS
Revised Child Anxiety and
Depression Scale (RCADS)
47-item self-report for 8–18-year-olds
The Revised Child Anxiety and Depression Scale (RCADS) is a 47-item measure designed to
assess symptoms corresponding to anxiety disorders and depression in children and young
people aged 8–18 years. The original measure includes six subscales aimed at assessing
separation anxiety disorder, social phobia, generalised anxiety disorder, panic disorder,
obsessive compulsive disorder and major depressive disorder.
                                                                      Test-retest                                Sensitivity to
                             Internal consistency                     reliability          Validity              change
                                       ✓                 ✓                    ?                       ✓                   ✓
Psychometric features             (Scale)            (Subscale)
                             Brevity                   Availability               Ease of Scoring          Used in the UK
Implementation
features                                   ✕                      ✓                        ✓                          ✓
*Please note that our assessment of this measure is based solely on the English self-report version of the RCADS, for children and
young people aged 8–18 years. The other versions of this measure were not assessed and therefore it should not be assumed
that they would receive the same rating.
  What is this document?
  This assessment of the Revised Child Anxiety and Depression Scale (RCADS) has been produced by the Early
  Intervention Foundation (EIF) as part of guidance on selecting measures relating to parental conflict and its
  impact on children. To read the full guidance report and download assessments of other measures, visit:
  https://www.eif.org.uk/resource/measuring-parental-conflict-and-its-impact-on-child-outcomes
              •   Some of the RCADS items contain sensitive content (for example item 37: ‘I think about death’). If an
                  individual raises issues around self-harm, suicide or related issues, they should either be referred to the
                  relevant mental health services or the appropriate safeguarding procedures should be put in place.
              •   We found insufficient evidence to establish that the RCADS has good test-retest reliability over short
                  periods of time.
              •   From our review of the evidence, it appears that the six subscales of the RCADS have a good validity, while
                  that of the total score is questionable. We would therefore encourage you to use the individual subscale
                  scores rather than the total score.
CHILD OUTCOMES MEASURE: RCADS                                     1                        EARLY INTERVENTION FOUNDATION | MARCH 2020
About the measure
 Author(s)/                     Publication year           Type of measure
 developer(s)                   for the original
 Chorpita, B.F.,                version of the
 Yim, L., Moffitt, C.,          measure
 Umemoto L.A., &
 Francis, S.E.                  2000                       Child self-report.
Versions available               There are three additional versions of this measure available,
                                 including a parent version (RCADS-P), a shortened 25-item
                                 child self-report version and a shortened 25-item parent
                                 version.
Outcome(s)                       This measure has been designed to assess anxiety disorders
assessed                         and depression in children and young people.
Subscales                        There are six subscales: separation anxiety disorder (SAD),
                                 social phobia (SP), generalised anxiety disorder (GAD), panic
                                 disorder (PD), obsessive compulsive disorder (OCD) and
                                 major depressive disorder (MDD).
                                 The RCADS also yields a Total Anxiety Scale (sum of the five
                                 anxiety subscales) and a Total Internalising Scale (sum of all
                                 six subscales).
Purpose/primary use              The RCADS measures the reported frequency of various
                                 symptoms of anxiety and low mood. It was developed as
                                 a revision of the Spence Children’s Anxiety Scale (SCAS)
                                 in order to correspond to the dimensions of some anxiety
                                 disorders reported in the Diagnostic and Statistical Manual
                                 of Mental Disorders (DSM-5), and also include major
                                 depression. In particular, the RCADS was intended to refine
                                 the measurement of generalised anxiety disorder (GAD) to
                                 reflect core aspects of ‘worry’ (Wigham & Conachie, 2014).
Mode of                          This measure can be completed in person or online.
administration
Example item                     ‘I worry about things.’
Target population                This measure was originally developed for children aged
                                 8–18 years.
CHILD OUTCOMES MEASURE: RCADS                         2                     EARLY INTERVENTION FOUNDATION | MARCH 2020
Response format                 4-point ordinal scale (0 = ‘Never’, 1 = ‘Sometimes’, 2 = ‘Often’,
                                3= ‘Always’)
Strengths &                     Strengths:
limitations
                                • The RCADS is a valid measure with good internal
                                  consistency.
                                • It is free to access and easy to score (the measure is
                                  available at: https://www.childfirst.ucla.edu/resources/,
                                  with scoring instructions here: https://www.childfirst.ucla.
                                  edu/resources/).
                                Limitations:
                                • We found insufficient evidence to establish that the RCADS
                                  has good test-retest reliability over short periods of time.
                                • The RCADS has 47 items and might require more than 15
                                  minutes to be completed.
                                • According to our review, it does not appear that the RCADS
                                  has UK cut-off scores.
Link                            https://www.childfirst.ucla.edu/resources/
Contact details                 Bruce Chorpita: chorpita@ucla.edu
Copyright                       The English and translated versions of the RCADS are
                                copyrighted by Chorpita and Spence. Any use of these
                                instruments implies that the user has read and agreed
                                to the terms of use. Neither the developers nor UCLA are
                                responsible for any third-party use of these instruments by
                                individuals who have not read the RCADS guide or its terms of
                                use. While the RCADS can be used for research purposes, the
                                developers ask, as a professional courtesy, to be informed of
                                this before the study is conducted. Finally, the use of RCADS
                                should always include acknowledgement of the development
                                of the RCADS using appropriate scholarly citations, including
                                the item development contributed by Spence (1997) and
                                extensions by Chorpita et al. (2000).
Key reference(s)                Chorpita, B.F., Yim, L.M., Moffitt, C. ., Umemoto L.A., & Francis,
                                S.E. (2000). Assessment of symptoms of DSM-IV anxiety
                                and depression in children: A Revised Child Anxiety and
                                Depression Scale. Behaviour Research and Therapy, 38,
                                835–855.
                                Spence, S.H. (1997). Structure of anxiety symptoms among
                                children: A confirmatory factor-analytic study. Journal of
                                Abnormal Psychology, 106, 280–297.
CHILD OUTCOMES MEASURE: RCADS                        3                  EARLY INTERVENTION FOUNDATION | MARCH 2020
Psychometric features in detail
Internal
consistency
                                de Ross et al. (2002) reported an alpha coefficient of 0.96 for the
                                whole scale. This study was conducted in Australia with a sample of
         ✓
                                405 children aged between 8–18 years (mean age = 13.24,
       (Scale)
                                SD = 2.52).
                                We found a number of papers (Brown et al., 2013; Chorpita et al.
                                2000; Chorpita et al., 2005; Donnelly et al., 2019) reporting good
       ✓                        internal consistency for the subscales of RCADS, with Cronbach’s
   (Subscales)                  alpha values ranging from 0.64 to 0.96.
                                De Ross et al. (2002) reported alpha coefficient values between 0.79
                                and 0.88 for the RCADS subscales.
                                Donnelly et al. (2019) reported that the internal consistency for
                                the RCADS subscales ranged from 0.69 to 0.96. This study was
                                conducted in Ireland with a sample of 350 second-level students
                                (186 female) aged between 12–18 years (mean age = 14.97,
                                SD = 1.44). The majority of students identified themselves as
                                White (91.4%).
                                The developers (Chorpita et al., 2000) examined the subscales’
                                internal consistency and reported that all alpha coefficient values
                                ranged between 0.71 and 0.85. This study was conducted in Hawaii
                                with a sample of 246 children (137 females). The mean age was
                                12.20 years and the major ethnic groups included were Filipino
                                (29.9%), Japanese American (12.5%), Caucasian (9.4%), Hawaiian
                                (8.9%) and Multi-ethnic (20.1%).
                                In another study by the developers, Chorpita et al. (2005) examined
                                the internal consistency of the subscales in a clinical sample and
                                reported that all α coefficient values ranged between 0.78 and 0.88.
                                This study was conducted in Hawaii with a sample of 513 children
                                (167 females) aged between 7–17 years referred for assessment
                                to the University of Hawaii Center for Cognitive Behavior Therapy.
                                The mean age was 12.9 years (SD = 2.7), and the major ethnicities
                                reported were Caucasian (16.0%), Hawaiian (10.3%), Japanese
                                American (9.6%), Filipino (5.3%), and Multi-ethnic (43.3%).
                                Finally, Brown et al. (2013) reported that the internal consistency
                                of the RCADS subscales ranged from 0.64 to 0.82. This study was
                                conducted in the US with a sample of 229 primarily low-income,
                                urban African American children and adolescents (111 females)
                                aged between 7–17 years (mean age = 12.13 years).
CHILD OUTCOMES MEASURE: RCADS                            4                  EARLY INTERVENTION FOUNDATION | MARCH 2020
Test-retest                     In Chorpita et al. (2000), a subset of participants (125 children) was
reliability                     included in a one-week test-retest analysis. The authors reported
                                test-retest coefficients between of 0.75 and 0.80 for all subscales
                                except OCD (test-retest coefficient = 0.65). For boys only, the MDD
                                subscale had a test-retest coefficient of 0.64.
           ?
Validity                        From our review of the evidence, it appears that the six subscales of the
                                RCADS have a good validity, while that of the total score is questionable.
                                We would therefore encourage you to use the individual subscale scores
                                rather than the total score.
          ✓
                                de Ross et al. (2002) conducted a confirmatory factor analysis and
                                reported CFI = 0.83(6 factor) and RMSEA = 0.063 for six factors, and CFI
                                = 0.72 and RMSEA = 0.081 for one factor. This study was conducted in
                                Australia with a sample of 405 children aged between 8–18 years (mean
                                age = 13.24, SD = 2.52).
                                Donnelly et al. (2019) conducted a confirmatory factor analysis for
                                six factors and reported CFI = 0.96, RMSEA = 0.034. This study was
                                conducted in Ireland with a sample of 350 second-level students (186
                                female) aged between 12–18 years (mean age = 14.97, SD = 1.44). The
                                majority of students identified themselves as White (91.4%).
                                de Ross et al. (2002) reported that the RCADS subscales were
                                significantly associated with the Revised Children's Manifest Anxiety
                                Scale (RCMAS) subscales and that the Pearson coefficients ranged
                                between 0.62 and 0.75. The authors also reported that the RCADS MMD
                                (Major depressive disorder) subscale score was significantly associated
                                with the Children's Depression Inventory (CDI) (r = 0.80).
                                Donnelly et al. (2019) reported that both the RCADS MDD subscale and
                                RCADS total internalising factor were most strongly correlated with the
                                DASS-21 depression subscale (r = 0.79 for MDD and r = 0.73 for the
                                total internalising factor) compared to the DASS-21 anxiety subscale.
                                The RCADS PD (Panic Disorders) subscale and the RCADS total anxiety
                                subscale were reported to be most strongly correlated with the DASS-
                                Anxiety subscale (r = 0.72 and r = 0.71 respectively).
                                Chorpita et al. (2000) reported that the RCADS MMD (Major depressive
                                disorder) subscale score was associated with the Children's Depression
                                Inventory (CDI) (r = 0.70). The other subscales showed low correlations
                                with the CDI (r ranged between 0.18 and 0.45). The authors also
                                evaluated the correlations of the RCADS with the Revised Children's
                                Manifest Anxiety Scale (RCMAS). It was predicted that the RCADS social
                                phobia (SP) subscale would correlate somewhat higher with the RCMAS-
                                Worry and RCMAS-P subscales, but correlations were low in particular
                                with RCMAS-Physiological Anxiety (r = 0.43). It was expected that the
                                obsessive-compulsive disorder (OCD) subscale should correlate relatively
                                higher with the RCMAS-Worry, but correlation was low (r = 0.44). Validity
                                coefficients were generally elevated among girls relative to the boys.
CHILD OUTCOMES MEASURE: RCADS                             5                  EARLY INTERVENTION FOUNDATION | MARCH 2020
Sensitivity to                  There is evidence that the RCADS can detect changes after
change                          participation in short and long mental health interventions in
                                children.
                                Stallard et al. (2014) reported that the RCARDS was sensitive to
                                change (RCADS: interaction co-efficient = −3.91, p < 0.0004). This
          ✓                     study was a 12-month impact evaluation of the FRIENDS for Life
                                (health-led) programme, aimed at improving resilience, mental health
                                and wellbeing in children. This study was conducted with a sample
                                of 1,442 children across 45 schools between the ages of 9 and 10
                                where just under a third experienced bullying ≥two to three times per
                                month.
                                Humphrey (2019) reported that the RCADS detected change over
                                time (RCADS: t(53) = 3.89, p < 0.01). This study was a one group
                                pre-test/post-test design carried out in the UK aimed at evaluating
                                the Growing2gether programme (lasting 17–18 weeks) designed
                                to develop confidence and self-belief in disengaged youth. This
                                study was conducted with a sample of 72 participants with a range
                                of risk factors such as in care, eligibility for free school meals,
                                demonstratable behavioural problems, withdrawn social behaviour
                                or victims of bullying, or are receiving counselling. Participants were
                                between the ages of 12–16 years old with a mean age of 14.0 and
                                77% were female.
Implementation features in detail
Brevity                         This measure has 47 items.
Availability                    The measure is available for use through Dr Chorpita’s UCLA
                                resource page at no cost (www.childfirst.ucla.edu/resources.html).
                                It does not require a clinical licence to be used.
CHILD OUTCOMES MEASURE: RCADS                             6                  EARLY INTERVENTION FOUNDATION | MARCH 2020
Ease of                         The measure has simple scoring instructions involving basic
scoring                         calculations. It does not need to be scored by someone with
                                specific training or qualifications. The measure can be scored
                                either manually or by using an automated scoring procedure.
                                Scoring instructions can be found at https://www.childfirst.ucla.
          ✓                     edu/resources/. Each item is assigned a numerical value from 0 to
                                3, and the values for the individual items are added together.
                                It is not clear if there is any information about the cut-offs of the
                                RCADS for the UK population, there are, however, cut-offs for the US
                                population.
Used in the                     The RCADS is a commonly used measure which has been
UK                              used in several UK studies, including in the assessment of the
                                DISCOVER Programme, the FRIENDS programme, the UK Resilience
                                Programme, the Personal, Social, Health and Economic (PSHE)
                                Education is the school curriculum and Growing2gether (Challen,
          ✓                     Machin, & Gillham 2014; Humphrey K., 2019; Michelson et al., 2016;
                                Stallard et al., 2014).
Language(s)                     The RCADS is available in English and has also been officially
                                translated into 16 other languages, including French, German,
                                Spanish, Chinese, Dutch, Danish and Greek. The official translations
                                can be found at: https://www.childfirst.ucla.edu/resources/.
CHILD OUTCOMES MEASURE: RCADS                            7                  EARLY INTERVENTION FOUNDATION | MARCH 2020
References
Brown R.C., Yaroslavsky I., Quinoy, A.M., Friedman A.D., Brookman R.R., & Southam-Gerow M.A. (2012) Factor
 structure of measures of anxiety and depression symptoms in African American youth. Child Psychiatry Hum
 Dev, 44(4), 525–536.
Challen, A.R., Machin, S.J., & Gillham, J.E. (2014). The UK Resilience Programme: A school-based universal
 nonrandomized pragmatic controlled trial. Journal of Consulting and Clinical Psychology, 82(1), 75–89.
Childs, J., Deighton, J., & Wolpert, M. (2013). Defining and measuring mental health and wellbeing: A response
 mode report requested by the Department of Health for the Policy Research Unit in the Health of Children, Young
 People and Families. Retrieved from http://www.ucl.ac.uk/ebpu/docs/publication_files/Defining_and_measuring_
 mental_health_and_wellbeing_in_children-CPRU_RM_report.pdf
Chorpita, B.F., Yim, L.M., Moffitt, C.E., Umemoto L.A., & Francis, S.E. (2000). Assessment of symptoms of DSM-
 IV anxiety and depression in children: A Revised Child Anxiety and Depression Scale. Behaviour Research and
 Therapy, 38, 835–855.
Chorpita, B.F., Moffitt, C.E., & Gray, J.A. (2005). Psychometric properties of the Revised Child Anxiety and
 Depression Scale in a clinical sample. Behaviour Research and Therapy, 43, 309–322.
de Ross, R.L., Gullone, E., & Chorpita, B.F. (2002). The Revised Child Anxiety and Depression Scale: A psychometric
 investigation with Australian youth. Behaviour Change, 19, 90–101.
Donnelly, A., Fitzgerald, A., Shevlin, M., & Dooley, B. (2019). Investigating the psychometric properties of the
 revised child anxiety and depression scale (RCADS) in a non-clinical sample of Irish adolescents. Journal of
 Mental Health, 28(4), 345–356.
Humphrey, K. (2019). Growing2gether Impact Report (February 2019–July 2019). Growing2gether Scottish Youth
 Mentoring Children. Retrieved from https://www.ecologia.org.uk/wp-content/uploads/2019/08/AFC-2-Cohort-1-
 Evaluation-Report-July-2019-7.pdf.
Law, D., & Wolpert, M. (2014). Guide to using outcomes and feedback tools with children, young people and
 families. UK: Press CAMHS.
Michelson, D., Sclare, I., Stahl, D., Morant, N., Bonin, E.M., & Brown, J.S. (2016). Early intervention for depression
 and anxiety in 16–18-year-olds: Protocol for a feasibility cluster randomised controlled trial of open-access
 psychological workshops in schools (DISCOVER). Contemporary Clinical Trials, 48, 52–58.
Weiss, D.C. & Chorpita, B.F. (2011). Revised Children’s Anxiety and Depression Scale – User’s Guide. Child F.I.R.S.T.
Wigham, S., & McConachie, H. (2014). Systematic review of the properties of tools used to measure outcomes in
 anxiety intervention studies for children with autism spectrum disorders. PloS one, 9(1), e85268.
Spence, S.H. (1997). Structure of anxiety symptoms among children: A confirmatory factor-analytic study. Journal
 of Abnormal Psychology, 106, 280–297.
Stallard, P., Taylor, G., Anderson, R., Daniels, H., Simpson, N., Phillips, R., & Skryabina, E. (2014). The prevention of
 anxiety in children through school-based interventions: Study protocol for a 24-month follow-up of the PACES
 project. Trials, 15(1), 77.
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                                First published in March 2020. © 2020
CHILD OUTCOMES MEASURE: RCADS                                      8                            EARLY INTERVENTION FOUNDATION | MARCH 2020