Reliability and Validity of Urdu Children Anxiety Sensitivity Index (CASI) Scale

  • Anowra Khan National University of Science and Technology
  • Tamkeen Ashraf Malik, Dr Department of Behavioral Science, School of Social Sciences, NUST University, Islamabad, Pakistan
Keywords: Anxiety Sensitivity, Trans-diagnostic risk factor, Anxiety Disorders, Children anxiety sensitivity index, Cultural Adaptation, ROC curve analysis


Objective. Anxiety sensitivity has been implicated as a trans-diagnostic risk factor for various
psychopathologies. Childhood anxiety sensitivity index (CASI) is an eighteen-item self-reported measure of
anxiety sensitivity. The present research aimed to translate and adapt CASI into Urdu language, analyze the
psychometric properties, factor structure and assess it as a screening scale for anxiety disorders in children.

Method. A cross-sectional research design was used to collect data from 658 participants (age 6 to 17 years;
M=13.24, SD=2.51) by using CASI and Screen for anxiety and emotional related disorders (SCARED)
self-report and parent-report.

Results. Exploratory factor analysis yields four factor structure explaining 32.98% accumulative variance.
Confirmatory factor analysis supported a three-factor hierarchical factor (χ2 = 152.52, df= 87, χ2/ df= 1.75
RMSEA= .05, CFI= .92, SRMR= .05, AIC= 218.52). ROC Curve analysis indicated CASI as a potential
screening measure for anxiety disorders with a sensitivity of >.80 and specificity of >.58 at a cut score of 20
to 23.

Conclusion. Study findings indicate that Urdu CASI may be used as a screening tool of anxiety disorders
in children. Suggestions for further research are proposed in the light of the present research findings.


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Author Biography

Tamkeen Ashraf Malik, Dr, Department of Behavioral Science, School of Social Sciences, NUST University, Islamabad, Pakistan

Associate Professor


Adornetto, C., Hensdiek, M., Meyer, A., In-Albon, T., Federer, M., & Schneider, S. (2008). The factor structure of the Childhood Anxiety Sensitivity Index in German children. Journal of Behavior Therapy and Experimental Psychiatry, 39(4), 404–416.
Ahmed, S., Malik, T. A., & Naveed, A. (2020). Adaptation and Concurrent Validity of Screen for Children Anxiety Related Emotional Disorders ( SCARED ) Adaptation and Concurrent Validity of Screen for Children Anxiety Related Emotional Disorders ( SCARED ). Nust Journal of Social Sciences and Humanities, 6(1), 29–43.
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335.
Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–1236.
Chorpita, B. F., & Daleiden, E. L. (2000). Properties of the Childhood Anxiety Sensitivity Index in children with anxiety disorders: Autonomic and nonautonomic factors. Behavior Therapy, 31(2), 327–349.
Curry, J. F., March, J. S., & Hervey, A. S. (2004). Comorbidity of Childhood and Adolescent Anxiety Disorders Prevalence and Implications. In T. H. Ollendick & J. S. March (Eds.), Phobic and Anxiety Disorders in Children and Adolescents (2nd ed., pp. 116–140). Oxford University Press.
Deacon, B. J., Valentiner, D. P., Gutierrez, P. M., & Blacker, D. (2002). The anxiety sensitivity index for children: Factor structure and relation to panic symptoms in an adolescent sample. Behaviour Research and Therapy, 40(7), 839–852.
Feldner, M. T., Leen-Feldner, E. W., Trainor, C., Blanchard, L., & Monson, C. M. (2008). Smoking and posttraumatic stress symptoms among adolescents: does anxiety sensitivity matter? Addictive Behaviors, 33(11), 1470–1476.
Fernández-Valdés, J., Gavino, A., Valderrama-Martos, L., Godoy, A., & Laurent, J. (2017). Propiedades psicométricas de la versión española del Índice de Sensibilidad a la Ansiedad para Niños. Psicothema, 29(3), 402–407.
Francis, S. E., Noël, V. A., & Ryan, S. L. (2019). A Systematic Review of the Factor Structure of Anxiety Sensitivity Among Children: Current Status and Recommendations for Future Directions. Child & Youth Care Forum, 48(5), 603–632.
Fullana, M. A., Servera, M., Weems, C. F., Tortella-Feliu, M., & Caseras, X. (2003). Psychometric properties of the childhood anxiety sensitivity index in a sample of Catalan school children. Anxiety, Stress and Coping, 16(1), 99–107.
Hudson, J. L., Rapee, R. M., Lyneham, H. J., McLellan, L. F., Wuthrich, V. M., & Schniering, C. A. (2015). Comparing outcomes for children with different anxiety disorders following cognitive behavioural therapy. Behaviour Research and Therapy, 72, 30–37.
Ibbad, S., Baig, L. A., Ahmer, Z., & Shahid, F. (2022). Prevalence of anxiety and depression in high school students of Karachi, Pakistan. Pakistan Journal of Medical Sciences, 38(4Part-II), 916.
Knapp, Ashley Arehart. (2016). Test of an Adolescent Anxiety Sensitivity Amelioration Program (AASAP) for At-Risk Youth [University of Arkanas].
Knapp, Ashley A., Blumenthal, H., Mischel, E. R., Badour, C. L., & Leen-Feldner, E. W. (2016). Anxiety Sensitivity and Its Factors in Relation to Generalized Anxiety Disorder among Adolescents. Journal of Abnormal Child Psychology, 44(2), 233–244.
Leen-Feldner, E. W., Feldner, M. T., Bernstein, A., McCormick, J. T., & Zvolensky, M. J. (2005). Anxiety Sensitivity and Anxious Responding to Bodily Sensations: A Test among Adolescents Using a Voluntary Hyperventilation Challenge. Cognitive Therapy and Research, 29(5), 593–609.
Lejuez, C. W., Paulson, A., Daughters, S. B., Bornovalova, M. A., & Zvolensky, M. J. (2006). The association between heroin use and anxiety sensitivity among inner-city individuals in residential drug use treatment. Behaviour Research and Therapy, 44(5), 667–677.
Lo, H. H. M., Yeung, J. W. K., Duncan, L. G., Ma, Y., Siu, A. F. Y., Chan, S. K. C., Choi, C. W., Szeto, M. P., Chow, K. K. W., & Ng, S. M. (2018). Validating of the Interpersonal Mindfulness in Parenting Scale in Hong Kong Chinese. Mindfulness, 9(5), 1390–1401.
MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4(1), 84–99.
Manly, J. T. (2005). Advances in research definitions of child maltreatment. Child Abuse & Neglect, 29(5), 425–439.
McHugh, R. K. (2019). Assessing anxiety sensitivity. In S. Smits, Jasper;Otto, Michael; Powers, Mark; Baird (Ed.), The Clinician’s Guide to Anxiety Sensitivity Treatment and Assessment (1st ed., pp. 9–29). Academic Press.
Naragon-Gainey, K. (2010). Meta-Analysis of the Relations of Anxiety Sensitivity to the Depressive and Anxiety Disorders. Psychological Bulletin, 136(1), 128–150.
Noël, V. A., & Francis, S. E. (2011). A meta-analytic review of the role of child anxiety sensitivity in child anxiety. Journal of Abnormal Child Psychology, 39(5), 721–733.
Pakistan Bureau of Statistics. (2017). Provisional Summary Results of 6TH Population and Housing Census-2017. TEHSIL WISE FOR WEB CENSUS_2017.pdf
Paulus, D. J., Kauffman, B. Y., Garey, L., Jardin, C., Manning, K., Bakhshaie, J., Garza, M., Ochoa-Perez, M., Lemaire, C., & Zvolensky, M. J. (2018). Examining the Synergistic Effects of Two Transdiagnostic Vulnerability Factors in Relation to Anxiety and Depressive Symptoms and Disorders Among Latinos in a Community Health Care Setting. Behavior Modification, 42(5), 661–683.
Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy.
Reiss, S., Silverman, W. K., & Weems, C. F. (2001). AS.pdf. In M. W. Vassey & R. Dadds, Mark (Eds.), Developmental psychopathology of Anxiety (pp. 109–128). Oxford University Press.
Schmidt, N. B., Keough, M. E., Timpano, K. R., & Richey, J. A. (2008). Anxiety sensitivity profile: predictive and incremental validity. Journal of Anxiety Disorders, 22(7), 1180–1189.
Schreier, S. S., Heinrichs, N., Alden, L., Rapee, R. M., Hofmann, S. G., Chen, J., Oh, K. J., & Bögels, S. (2010). Social anxiety and social norms in individualistic and collectivistic countries. Depression and Anxiety, 27(12), 1128–1134.
Silverman, Wendy, K., Goedhart, Arnold, W., Barrett, P., & Turner, C. (2003). The facets of anxiety sensitivity represented in the Childhood Anxiety Sensitivity Index: Confirmatory analyses of factor models from past studies. Journal of Abnormal Psychology, 112(3), 364–374.
Taylor, S. (Ed.). (1998). Anxiety Sensitivity: Theory, Research, and Treatment of the Fear of Anxiety. Lawrence Erlbaum Associates.
Velasco, R. V., Bakhshaie, J., Walker, R. L., Viana, A. G., Garza, M., Ochoa-Perez, M., Paulus, D. J., Robles, Z., Valdivieso, J., & Zvolensky, M. J. (2016). Synergistic effects of pain intensity and anxiety sensitivity in relation to anxiety and depressive symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting. Journal of Anxiety Disorders, 43, 23–31.
Walsh, T. M., Stewart, S. H., McLaughlin, E., & Comeau, N. (2004). Gender differences in Childhood Anxiety Sensitivity Index (CASI) dimensions. Journal of Anxiety Disorders, 18(5), 695–706.
Weems, C. F., Taylor, L. K., Marks, A. B., & Varela, R. E. (2010). Anxiety sensitivity in childhood and adolescence: Parent reports and factors that influence associations with child reports. Cognitive Therapy and Research, 34(4), 303–315.
Weiss, D. D., & Last, C. G. (2001). Developmental Variations in the Prevalence and Manifestation of Anxiety Disorders. In W. Vasey, Michael & R. Dadds, Mark (Eds.), The Developmental Psychopathology of Anxiety (1st ed., pp. 44–59). Oxford University Press.
World Health Organization. (2010). Process of translation and adaptation of instruments. WHO; World Health Organization.
Wright, K. D., Asmundson, G. J. G., McCreary, D. R., Stewart, S. H., McLaughlin, E., Comeau, M. N., & Walsh, T. M. (2010). Confirmatory factor analysis of the childhood anxiety sensitivity index: A gender comparison. Cognitive Behaviour Therapy, 39(3), 225–235.
Zvolensky, M. J., Bakhshaie, J., Garza, M., Paulus, D. J., Valdivieso, J., Lam, H., Bogiaizian, D., Robles, Z., Schmidt, N. B., & Vujanovic, A. (2015). Anxiety sensitivity and mindful attention in terms of anxiety and depressive symptoms and disorders among Latinos in primary care. Psychiatry Research, 229(1–2), 245–251.
Zvolensky, M. J., Paulus, D. J., Bakhshaie, J., Garza, M., Valdivieso, J., Ochoa-Perez, M., Reitzel, L. R., Viana, A. G., Lemaire, C., Bogiaizian, D., Robles, Z., Manning, K., Mayorga, N. A., Schmidt, N. B., & Collado, A. (2018). Anxiety sensitivity and rumination: Transdiagnostic factors involved in the relation between subjective social status and anxiety and depressive symptoms and disorders among economically disadvantaged Latinos in primary care. American Journal of Orthopsychiatry, 88(5), 571–581.