P-216 Emotional Assessment in the Waiting Room: Are Caregivers Aware of Their Child's Anxiety?. (March 2016)

• Record Type: Journal Article
• Authors: Polokowski, Ashley; Trubowitz, Lianna; Strano, Amanda; Reigada, Laura
• Is Part Of: Inflammatory bowel diseases. Volume 22(2016:Mar.)Supplement 1
• Publication Date: 2016-03
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/01.MIB.0000480333.75823.1d
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Anxiety symptoms are associated with worsened psychosocial and health outcomes in children and adolescents with inflammatory bowel disease (IBD). Accordingly, emotional assessments, typically consisting of separate child and caregiver reports, are being implemented within medical settings. Yet, for pediatric IBD patients, there has been little investigation into the utility of these assessments. One indicator of diagnostic accuracy is high agreement between child and caregiver reports. While rates of anxiety agreement typically have been found to be low to moderate for healthy and chronically ill populations, anxiety agreement is unknown in a pediatric IBD sample and their caregivers. The aim of this study is to identify agreement and patterns of anxiety symptom reporting in a pediatric sample diagnosed with IBD and their caregivers. Methods: A total of 237 pediatric IBD patients and their caregivers were administered the Screen for Child Anxiety Related Disorders (SCARED; Birmaher et al, 1997) in their gastroenterologist's office waiting room. The SCARED, is a 41-item questionnaire consisting of a child and caregiver version that assesses the frequency of anxiety symptoms in children on a scale of 0 to 82. Excellent internal consistency was found for caregiver (α = 0.93) and child (α = 0.92) versions. The SCARED measures 5 domains of anxiety: panic disorder/somatic, generalized, social, school, and separation. Patients were included in the study if they (1) were between the ages of 8 and 17, (2) had a confirmed IBD diagnosis, (3) completed the SCARED, and (4) had a caregiver that completed the SCARED. Intra-class correlation coefficients (ICCs) were used to assess agreement between child and caregiver's report of anxiety symptoms on the 5 domains and total score, and Kappa coefficients were calculated to assess agreement on established cutoffs (>20 = at-risk; >25 = clinical cutoff). Results: The final sample consisted of 187 pediatric patients (53% male) ages 8 to 17 (M = 13.54, SD = 2.44) with IBD. The majority of patients were white (83%), and had a diagnosis of Crohn's disease (76%). Overall, a good level of agreement was found between caregiver and child self-report on all anxiety domains (ICC = 0.69–0.75) and total SCARED (ICC = 0.79). On average, children (M = 15.50, SD = 11.58) reported experiencing more anxiety symptoms than their caregiver (M = 13.55, SD = 11.68). Good agreement was found on clinical and at-risk cutoffs for the total SCARED, with 24% of children and 17% of caregivers reporting anxiety symptoms above the clinical cutoff (κ = 0.49), and 33% of children and 25% of caregivers reporting anxiety symptoms above the at-risk cutoff, (κ = 0.51). Conclusions: Overall, the fairly consistent reports between children and their caregivers points to strong caregiver awareness of child's anxiety symptoms. In particular, our study found good child and caregiver agreement on whether the child exceeds the threshold for clinical anxiety, supporting the use of the SCARED to identify pediatric IBD patients at risk for anxiety. Yet, the consistent trend of caregivers reporting fewer symptoms than children indicates that the child's report may provide a more inclusive assessment of anxiety symptoms. Thus, it may be useful to consider both child and caregiver anxiety reports in the identification, assessment, and future treatment of anxiety.