Common use of Discriminant validity Clause in Contracts

Discriminant validity. The majority of analyses suggest adequate discriminant validity between HC’s and patients for Total, GA, and SA subscales of the SCARED. For the treatment-seeking sample, both child and parent reports of anxiety were significantly lower for HCs than anxious participants. This is consistent with prior studies that utilize diagnostic interviews to test the SCARED in treatment-seeking anxious patients and youth without psychopathology (▇▇▇▇▇▇ et al., 2009) and those with non-anxiety-related disorders (▇▇▇▇▇▇▇▇ et al., 1999; ▇▇▇▇▇ et al., 2013; ▇▇▇▇▇ et al., 2000; ▇▇▇▇▇ et al., 2004). However, results for child-report in the non-treatment- seeking sample were less compelling. Specifically, child-reports of anxiety did not discriminate between HCs and SAD or GAD on the Total scale and GA subscale, nor between HCs and comorbid GAD+SAD on the SA subscale. Few studies have assessed discriminant validity in anxious patients diagnosed with the disorders measured by the SCARED’s specific subscales, or among patients with comorbid anxiety diagnoses. Across all analyses and scales, and largely irrespective of informant, youth comorbid for GAD+SAD had more anxiety symptoms than other patients—as indexed by higher Total, GA, and SA scores (Figs 1-2, purple lines). Thus, youth with comorbid diagnoses had more severe levels of anxiety than individuals with a single diagnosis. This replicates prior work in patients tested with clinical interviews where severity was measured with questionnaires (▇▇▇▇▇▇▇▇▇-▇▇▇▇▇▇ et al., 2012). Support for discriminant validity between patient subtypes was also obtained across the majority of analyses among the treatment-seeking sample. GA scores were higher for GAD and GAD+SAD than SAD alone, while SA scores were higher for SAD and GAD+SAD than GAD alone. A similar pattern emerged for parent-report among the community sample. However, little evidence for discriminant validity was obtained for child- report in the community sample. Taken together, this suggests that in a treatment-seeking sample, the SCARED is able to discriminate between children with anxiety disorders and those free of any psychopathology, and between sub-types of anxious patients based on the subscale that is utilized. In a sample drawn from the community, child-report on the SCARED may be more heterogeneous and reflect a continuum of anxiety symptoms rather than the categorical expression of clinical characteristics. Yet, data from other studies demonstrate that in community settings, child-report on the SCARED has good convergent validity with other measures of anxiety (e.g., ▇▇▇▇▇, ▇▇▇▇▇, & ▇▇▇▇▇▇, 2002; ▇▇▇▇▇ et al., 1998a; ▇▇▇▇▇, ▇▇▇▇▇▇▇, & ▇▇▇▇▇▇▇▇▇▇▇, 2000; ▇▇ et al., 2008). Moreover, other facets of the SCARED’s psychometric properties including test-retest reliability (e.g., ▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇, ▇▇▇▇▇▇, & ▇▇▇▇▇▇▇▇, 2003; ▇▇▇▇▇ et al., 1999; ▇▇ et al., 2008) and internal consistency (e.g., ▇▇▇▇ et al., 2003; ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇-▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇, & ▇▇▇▇▇, 2013; ▇▇▇▇▇▇, ▇▇▇▇▇, ▇▇▇▇▇▇▇, ▇▇▇▇▇, & ▇▇▇▇▇▇, 2011; ▇▇ et al., 2008; ▇▇▇▇▇▇▇▇ et al., 2010) are well established with child-report in community samples. These properties have been confirmed across numerous countries and various languages (e.g., ▇▇▇▇▇▇▇▇, ▇▇▇▇, ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇, & ▇▇▇▇▇, 2009; ▇▇▇▇▇ et al., 2013; ▇▇▇▇▇▇ et al., 2011; ▇▇ et al., 2008; ▇▇▇▇▇-▇▇▇▇▇ et al., 2009). Thus, child-report data in community settings should not be discounted. Instead, researchers and clinicians are simply urged to consider whether child-report data discriminate between clinically meaningful subtypes of anxiety diagnoses in community samples or if such measures may better reflect a continuum of symptoms.

Discriminant validity. The majority of analyses suggest adequate discriminant validity between HC’s and patients for Total, GA, and SA subscales of the SCARED. For the treatment-seeking sample, both child and parent reports of anxiety were significantly lower for HCs than anxious participants. This is consistent with prior studies that utilize diagnostic interviews to test the SCARED in treatment-seeking anxious patients and youth without psychopathology (▇▇▇▇▇▇ et al., 2009) and those with non-anxiety-related disorders (▇▇▇▇▇▇▇▇ et al., 1999; Author Manuscript ▇▇▇▇▇ et al., 2013; ▇▇▇▇▇ et al., 2000; ▇▇▇▇▇ et al., 2004). However, results for child-report in the non-treatment- treatment-seeking sample were less compelling. Specifically, child-reports of anxiety did not discriminate between HCs and SAD or GAD on the Total scale and GA subscale, nor between HCs and comorbid GAD+SAD on the SA subscale. Author Manuscript Few studies have assessed discriminant validity in anxious patients diagnosed with the disorders measured by the SCARED’s specific subscales, or among patients with comorbid anxiety diagnoses. Across all analyses and scales, and largely irrespective of informant, youth comorbid for GAD+SAD had more anxiety symptoms than other patients—as indexed by higher Total, GA, and SA scores (Figs 1-21–2, purple lines). Thus, youth with comorbid diagnoses had more severe levels of anxiety than individuals with a single diagnosis. This replicates prior work in patients tested with clinical interviews where severity was measured with questionnaires (▇▇▇▇▇▇▇▇▇-▇▇▇▇▇▇ et al., 2012). Support for discriminant validity between patient subtypes was also obtained across the majority of analyses among the treatment-seeking sample. GA scores were higher for GAD and GAD+SAD than SAD alone, while SA scores were higher for SAD and GAD+SAD than GAD alone. A similar pattern emerged for parent-report among the community sample. However, little evidence for discriminant validity was obtained for child- child-report in the community sample. Taken together, this suggests that in a treatment-seeking sample, the SCARED is able to discriminate between children with anxiety disorders and those free of any psychopathology, and between sub-types of anxious patients based on the subscale that is utilized. Author Manuscript Author Manuscript In a sample drawn from the community, child-report on the SCARED may be more heterogeneous and reflect a continuum of anxiety symptoms rather than the categorical expression of clinical characteristics. Yet, data from other studies demonstrate that in community settings, child-report on the SCARED has good convergent validity with other measures of anxiety (e.g., ▇▇▇▇▇, ▇▇▇▇▇, & ▇▇▇▇▇▇, 2002; ▇▇▇▇▇ et al., 1998a; ▇▇▇▇▇, ▇▇▇▇▇▇▇, & ▇▇▇▇▇▇▇▇▇▇▇, 2000; ▇▇ et al., 2008). Moreover, other facets of the SCARED’s psychometric properties including test-retest reliability (e.g., ▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇, ▇▇▇▇▇▇, & ▇▇▇▇▇▇▇▇, 2003; ▇▇▇▇▇ et al., 1999; ▇▇ et al., 2008) and internal consistency (e.g., ▇▇▇▇ et al., 2003; ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇-▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇, & ▇▇▇▇▇, 2013; ▇▇▇▇▇▇, ▇▇▇▇▇, ▇▇▇▇▇▇▇, ▇▇▇▇▇, & ▇▇▇▇▇▇, 2011; ▇▇ et al., 2008; ▇▇▇▇▇▇▇▇ et al., 2010) are well established with child-report in community samples. These properties have been confirmed across numerous countries and various languages (e.g., ▇▇▇▇▇▇▇▇, ▇▇▇▇, ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇, & ▇▇▇▇▇, 2009; ▇▇▇▇▇ et al., 2013; ▇▇▇▇▇▇ et al., 2011; ▇▇ et al., 2008; ▇▇▇▇▇-- ▇▇▇▇▇ et al., 2009). Thus, child-report data in community settings should not be discounted. Instead, researchers and clinicians are simply urged to consider whether child-report data discriminate between clinically meaningful subtypes of anxiety diagnoses in community samples or if such measures may better reflect a continuum of symptoms.