Evaluating pediatric preoperative anxiety interventions requires statistically valid measurement tools. COMPARE.EDU.VN explores the modified Yale Preoperative Anxiety Scale (m-YPAS) and its comparison to the State-Trait Anxiety Inventory for Children (STAIC). This analysis provides insights into their efficacy and application in perioperative settings, offering a solution for accurate anxiety assessment. Understand the nuanced distinctions between these assessment methods, revealing their relevance in child healthcare.
1. Understanding Preoperative Anxiety in Children
Preoperative anxiety is a common issue among children undergoing surgical procedures. It manifests as fear, worry, and distress before, during, and after surgery. Effectively measuring and managing this anxiety is crucial for improving the child’s overall surgical experience and reducing potential long-term psychological effects. A reliable assessment tool not only aids in diagnosing the level of anxiety but also in evaluating the effectiveness of interventions designed to alleviate it. This ensures that healthcare professionals can tailor their approach to meet each child’s specific needs, thereby optimizing patient care and outcomes. The importance of early detection and intervention cannot be overstated, as high levels of preoperative anxiety can lead to increased pain perception, prolonged recovery times, and behavioral problems post-surgery.
1.1. The Significance of Accurate Anxiety Measurement
Accurate anxiety measurement is paramount in pediatric preoperative care for several reasons. Firstly, it allows healthcare providers to identify children at high risk of experiencing severe anxiety. Secondly, it facilitates the selection and implementation of appropriate interventions, such as pharmacological or non-pharmacological methods, to manage anxiety effectively. Thirdly, it provides a baseline for monitoring the effectiveness of these interventions, ensuring that they achieve the desired outcome of reducing anxiety levels. Moreover, reliable measurement tools contribute to research efforts aimed at understanding the causes and consequences of preoperative anxiety in children. The implications extend beyond immediate clinical care, influencing the development of best practices and guidelines for managing pediatric patients in perioperative settings.
1.2. Challenges in Assessing Pediatric Anxiety
Assessing anxiety in children presents unique challenges compared to assessing anxiety in adults. Children may have difficulty articulating their feelings, leading to reliance on observational measures and parent reports. Anxiety can manifest differently in children, ranging from overt displays of fear and crying to more subtle signs such as withdrawal and irritability. Furthermore, the perioperative environment itself can exacerbate anxiety, making it difficult to differentiate between baseline anxiety and situation-specific reactions. Cultural and developmental factors can also influence how children express and experience anxiety, necessitating the use of culturally sensitive and age-appropriate assessment tools. Overcoming these challenges requires a multifaceted approach that incorporates both subjective and objective measures, as well as the expertise of healthcare professionals trained in pediatric anxiety assessment.
2. The Yale Preoperative Anxiety Scale (YPAS)
The Yale Preoperative Anxiety Scale (YPAS) is an observational tool designed to assess anxiety in children undergoing anesthesia induction. It consists of five categories of behavior, each rated on a four-point scale, reflecting different levels of anxiety. These categories include activity, vocalizations, emotional expressiveness, state of arousal, and cooperation. Developed to provide a structured and standardized method for quantifying anxiety during induction, the YPAS has proven to be a valuable tool for researchers and clinicians alike. Its ease of use and relatively short administration time make it practical for busy perioperative settings. The YPAS helps bridge the gap in standardized anxiety assessment for pediatric patients, providing a means to evaluate interventions aimed at reducing preoperative anxiety.
2.1. Development and Original Purpose of YPAS
The development of the YPAS was driven by the need for a reliable and valid instrument to measure preoperative anxiety in children undergoing anesthesia induction. Recognizing the limitations of existing measures, researchers sought to create a tool that was specifically tailored to the perioperative environment and sensitive to the unique ways in which children express anxiety. The original purpose of the YPAS was to provide a standardized method for quantifying anxiety levels during induction, allowing for objective comparisons across different children and treatment groups. By focusing on observable behaviors, the YPAS aimed to minimize the reliance on subjective reports, which can be unreliable in young children. Its development marked a significant advancement in the field of pediatric anxiety assessment, laying the groundwork for further research and clinical applications.
2.2. Key Features and Scoring of YPAS
The YPAS encompasses five behavioral categories: activity, vocalizations, emotional expressiveness, state of arousal, and cooperation. Each category is rated on a scale from 1 to 4, where 1 represents minimal anxiety and 4 indicates high anxiety. Observers trained in using the YPAS rate each category based on their direct observation of the child’s behavior during anesthesia induction. The total YPAS score is calculated by summing the ratings across all five categories, resulting in a score range from 5 to 20. Higher scores indicate greater anxiety levels. The YPAS includes detailed behavioral anchors for each rating point, ensuring consistency and reliability across different observers. These anchors provide specific examples of behaviors that correspond to each rating level, minimizing subjective interpretation. The clear structure and straightforward scoring of the YPAS contribute to its practicality and widespread use in clinical and research settings.
3. The Modified Yale Preoperative Anxiety Scale (m-YPAS)
The Modified Yale Preoperative Anxiety Scale (m-YPAS) represents an adaptation and extension of the original YPAS, designed to broaden its applicability to the preoperative holding area. Recognizing that anxiety assessment should not be limited to the induction phase, researchers modified and expanded the YPAS to capture a wider range of behaviors exhibited by children in the holding area. The m-YPAS retains the core structure and scoring system of the original YPAS but includes revised items and behavioral anchors to reflect the context of the preoperative holding area. This modification allows for continuous monitoring of anxiety levels from the time the child enters the holding area until they are transferred to the operating room. The m-YPAS enhances the utility of the YPAS as a comprehensive assessment tool for pediatric preoperative anxiety.
3.1. Rationale for Modifying the Original YPAS
The rationale for modifying the original YPAS stemmed from the recognition that preoperative anxiety is a dynamic and evolving process. Anxiety levels can fluctuate throughout the perioperative period, influenced by factors such as parental separation, unfamiliar surroundings, and anticipation of the surgical procedure. Limiting assessment to the induction phase may overlook significant changes in anxiety levels occurring in the preoperative holding area. By extending the applicability of the YPAS to the holding area, researchers aimed to capture a more complete picture of the child’s anxiety experience. This would enable healthcare providers to identify children who may benefit from early interventions to reduce anxiety, thereby improving their overall perioperative outcomes. The modification of the YPAS reflects a shift towards a more holistic and patient-centered approach to pediatric preoperative care.
3.2. Changes and Enhancements in the m-YPAS
The modifications made to the YPAS to create the m-YPAS primarily involved revising the behavioral items and anchors to better reflect the behaviors observed in the preoperative holding area. Specific changes included adding items to capture behaviors such as clinging to parents, seeking reassurance, and displaying restlessness. The behavioral anchors were also modified to provide more detailed descriptions of these behaviors, ensuring that observers could accurately rate anxiety levels in the holding area. Additionally, the m-YPAS incorporated items to assess the child’s interaction with healthcare staff, such as their willingness to cooperate with medical procedures. These enhancements expanded the scope of the YPAS, allowing it to capture a broader range of anxiety-related behaviors and provide a more comprehensive assessment of the child’s emotional state in the preoperative holding area.
4. The State-Trait Anxiety Inventory for Children (STAIC)
The State-Trait Anxiety Inventory for Children (STAIC) is a self-report questionnaire designed to measure anxiety in children aged 9 to 12 years. Unlike the YPAS and m-YPAS, which are observational tools, the STAIC relies on the child’s own perception of their anxiety levels. The STAIC consists of two separate scales: the State Anxiety Scale and the Trait Anxiety Scale. The State Anxiety Scale measures anxiety as a temporary emotional state, reflecting how the child feels “right now” at the time of assessment. The Trait Anxiety Scale measures anxiety as a more stable personality characteristic, reflecting how the child generally feels across different situations. The STAIC provides valuable insights into both the situational and dispositional aspects of anxiety in children.
4.1. Purpose and Structure of STAIC
The primary purpose of the STAIC is to assess anxiety in children using a self-report format. This allows for the measurement of subjective experiences of anxiety that may not be readily observable. The STAIC is structured into two distinct scales, each consisting of a series of statements that the child rates on a three-point scale. The State Anxiety Scale includes statements such as “I feel nervous” and “I am worried,” while the Trait Anxiety Scale includes statements such as “I worry about things” and “I am a nervous person.” The child indicates the extent to which each statement applies to them, providing a quantitative measure of both state and trait anxiety levels. The STAIC is widely used in research and clinical settings to identify children with elevated anxiety and to evaluate the effectiveness of interventions aimed at reducing anxiety.
4.2. Scoring and Interpretation of STAIC Results
The scoring of the STAIC involves summing the ratings for each item within the State Anxiety Scale and the Trait Anxiety Scale separately. The resulting scores are then compared to normative data to determine the child’s anxiety levels relative to their peers. Higher scores on the State Anxiety Scale indicate greater levels of situational anxiety, while higher scores on the Trait Anxiety Scale indicate greater levels of dispositional anxiety. Interpretation of STAIC results requires consideration of both the State Anxiety Score and the Trait Anxiety Score, as well as the child’s individual characteristics and circumstances. For example, a child with a high State Anxiety Score but a low Trait Anxiety Score may be experiencing anxiety primarily in response to a specific situation, while a child with high scores on both scales may have a more generalized anxiety disorder. Clinical judgment is essential in interpreting STAIC results and developing appropriate treatment plans.
5. How Does it Compare: m-YPAS vs. STAIC
The m-YPAS and STAIC represent two distinct approaches to assessing anxiety in children. The m-YPAS is an observational tool that relies on direct observation of the child’s behavior, while the STAIC is a self-report questionnaire that relies on the child’s own perception of their anxiety levels. Each tool has its own strengths and limitations, making them suitable for different purposes and populations. The m-YPAS is particularly useful for assessing anxiety in young children who may have difficulty articulating their feelings, while the STAIC is more appropriate for older children who are able to provide reliable self-reports. Choosing the right tool depends on the child’s age, developmental level, and the specific goals of the assessment.
5.1. Methodology and Study Design
The study comparing the m-YPAS and STAIC involved a group of children undergoing surgical procedures. Researchers collected data using both the m-YPAS and STAIC to assess anxiety levels at different points in the perioperative period. The m-YPAS was administered by trained observers who recorded the child’s behavior in the preoperative holding area and during anesthesia induction. The STAIC was administered to children aged 9 to 12 years who were able to complete the self-report questionnaire. Statistical analyses were conducted to examine the relationship between the m-YPAS scores and the STAIC scores, as well as the reliability and validity of the m-YPAS. The study design aimed to provide a comprehensive evaluation of the m-YPAS and its comparison to a recognized “gold standard” measure of anxiety in children.
5.2. Reliability Analysis and Inter-Observer Agreement
Reliability analysis is a critical component of evaluating the quality of any measurement tool. In the study comparing the m-YPAS and STAIC, reliability analysis focused on assessing the consistency and stability of the m-YPAS scores. Inter-observer agreement was calculated to determine the extent to which different observers agreed on their ratings of the child’s behavior using the m-YPAS. Weighted kappa statistics were used to quantify the level of agreement, with values ranging from 0.68 to 0.86 indicating good to excellent agreement. Intra-observer reliability was also assessed to determine the consistency of ratings made by the same observer over time. The high levels of inter-observer and intra-observer reliability provide evidence that the m-YPAS is a reliable and consistent tool for assessing anxiety in children.
5.3. Concurrent Validity Assessment
Concurrent validity refers to the extent to which a new measurement tool correlates with an existing “gold standard” measure of the same construct. In the study comparing the m-YPAS and STAIC, concurrent validity was assessed by examining the relationship between the m-YPAS scores and the STAIC scores. A statistically significant correlation (P = 0.01, r = 0.79) was found between the two measures, indicating that the m-YPAS and STAIC are measuring similar aspects of anxiety. This provides evidence that the m-YPAS has acceptable concurrent validity, supporting its use as a valid measure of anxiety in children. The correlation coefficient of 0.79 suggests a strong positive relationship between the two measures, indicating that children who score high on the m-YPAS also tend to score high on the STAIC, and vice versa.
5.4. Construct Validity Evaluation
Construct validity refers to the extent to which a measurement tool accurately measures the theoretical construct it is intended to measure. In the study comparing the m-YPAS and STAIC, construct validity was evaluated by examining the changes in m-YPAS scores across different phases of the perioperative period. It was hypothesized that anxiety levels would increase as the child progressed from the preoperative holding area to the operating room and then to the introduction of the anesthesia mask. The results showed a statistically significant increase in m-YPAS scores from the preoperative holding area (28 +/- 8) to entering the operating room (35 +/- 12), to introduction of the anesthesia mask (43 +/- 15;F [1,36] = 0.6, P = 0.001]. This supports the construct validity of the m-YPAS, indicating that it is sensitive to changes in anxiety levels that would be expected based on theoretical understanding of anxiety in the perioperative period.
6. Strengths and Limitations of m-YPAS and STAIC
Both the m-YPAS and STAIC have distinct strengths and limitations that should be considered when selecting a tool for assessing anxiety in children. The m-YPAS offers the advantage of being an observational tool, making it suitable for assessing anxiety in young children who may have difficulty with self-report measures. However, it relies on the subjective judgment of trained observers, which can introduce bias. The STAIC, on the other hand, provides a direct measure of the child’s own experience of anxiety, but it is limited to children who are able to complete the self-report questionnaire. The choice between the m-YPAS and STAIC depends on the specific goals of the assessment and the characteristics of the child being assessed.
6.1. Advantages of m-YPAS
One of the primary advantages of the m-YPAS is its ability to assess anxiety in real-time through direct observation. This is particularly valuable in the perioperative setting, where anxiety levels can fluctuate rapidly in response to environmental stimuli and medical procedures. The m-YPAS also minimizes reliance on the child’s self-report, which can be unreliable due to developmental factors, language barriers, or cognitive impairments. The m-YPAS is relatively easy to administer and score, making it practical for use in busy clinical settings. It provides a standardized and structured method for quantifying anxiety, allowing for objective comparisons across different children and treatment groups. The m-YPAS is also sensitive to changes in anxiety levels, making it useful for monitoring the effectiveness of interventions aimed at reducing anxiety.
6.2. Disadvantages of m-YPAS
Despite its advantages, the m-YPAS also has several limitations. One of the primary disadvantages is its reliance on the subjective judgment of trained observers. This can introduce bias and variability in the ratings, especially if observers are not adequately trained or if they have pre-existing expectations about the child’s anxiety levels. The m-YPAS also focuses primarily on observable behaviors, which may not capture the full range of anxiety symptoms experienced by children. Some children may internalize their anxiety and not exhibit overt behavioral signs, leading to underestimation of their anxiety levels. The m-YPAS may also be influenced by situational factors, such as the presence of parents or healthcare staff, which can affect the child’s behavior. These limitations highlight the importance of using the m-YPAS in conjunction with other assessment methods, such as self-report questionnaires and parent reports, to obtain a more comprehensive picture of the child’s anxiety.
6.3. Advantages of STAIC
The STAIC offers the advantage of providing a direct measure of the child’s own experience of anxiety. This can provide valuable insights into the child’s subjective feelings and thoughts, which may not be readily observable. The STAIC is relatively easy to administer and score, making it practical for use in clinical settings. It is also a widely used and well-validated measure of anxiety in children, with extensive normative data available for comparison. The STAIC can be used to assess both state anxiety (anxiety in a specific situation) and trait anxiety (general tendency to be anxious), providing a comprehensive assessment of anxiety. The STAIC is also sensitive to changes in anxiety levels, making it useful for monitoring the effectiveness of interventions aimed at reducing anxiety.
6.4. Disadvantages of STAIC
The STAIC also has several limitations. One of the primary disadvantages is its reliance on the child’s ability to provide accurate and reliable self-reports. This can be problematic for young children who may have difficulty understanding the questionnaire items or expressing their feelings in a written format. The STAIC may also be influenced by social desirability bias, where children may underreport their anxiety levels in order to present themselves in a more positive light. The STAIC is also limited to children who are able to read and understand the questionnaire items, which may exclude children with cognitive impairments or language barriers. These limitations highlight the importance of using the STAIC in conjunction with other assessment methods, such as observational measures and parent reports, to obtain a more comprehensive picture of the child’s anxiety.
7. Practical Applications in Perioperative Settings
The m-YPAS and STAIC have numerous practical applications in perioperative settings for assessing and managing anxiety in children. The m-YPAS can be used to monitor anxiety levels in the preoperative holding area and during anesthesia induction, allowing healthcare providers to identify children who may benefit from interventions to reduce anxiety. The STAIC can be used to screen children for anxiety prior to surgery, identifying those who may be at higher risk of experiencing preoperative anxiety. Both tools can be used to evaluate the effectiveness of interventions aimed at reducing anxiety, such as pharmacological interventions, psychological interventions, and environmental modifications. The information obtained from these assessments can be used to tailor the care plan to meet the individual needs of each child, thereby improving their overall surgical experience.
7.1. Using m-YPAS for Continuous Monitoring
The m-YPAS is particularly well-suited for continuous monitoring of anxiety levels in the perioperative period. Trained observers can use the m-YPAS to assess anxiety levels at regular intervals, such as every 15 minutes, from the time the child enters the preoperative holding area until they are transferred to the operating room. This allows for the detection of changes in anxiety levels over time, providing valuable information for guiding clinical decision-making. For example, if a child’s anxiety level increases significantly after separation from their parents, healthcare providers can implement interventions to reduce anxiety, such as providing reassurance, distraction, or comfort items. Continuous monitoring with the m-YPAS can help ensure that children receive timely and appropriate support to manage their anxiety throughout the perioperative period.
7.2. Integrating STAIC for Preoperative Screening
The STAIC can be effectively integrated into preoperative screening protocols to identify children who may be at higher risk of experiencing preoperative anxiety. Children aged 9 to 12 years can complete the STAIC as part of their routine preoperative assessment, providing valuable information about their anxiety levels prior to surgery. Children who score high on the STAIC can be referred for further evaluation and intervention, such as psychological counseling or pharmacological treatment. Integrating the STAIC into preoperative screening can help ensure that children with elevated anxiety receive the support they need to manage their anxiety and improve their surgical outcomes. It also allows healthcare providers to proactively address anxiety concerns before they escalate, potentially preventing negative consequences such as increased pain perception, prolonged recovery times, and behavioral problems post-surgery.
7.3. Evaluating Intervention Effectiveness
Both the m-YPAS and STAIC can be used to evaluate the effectiveness of interventions aimed at reducing preoperative anxiety in children. Researchers and clinicians can use these tools to measure anxiety levels before and after the implementation of an intervention, such as a pharmacological intervention, a psychological intervention, or an environmental modification. By comparing the anxiety scores before and after the intervention, it is possible to determine whether the intervention has had a significant impact on anxiety levels. For example, a study might compare the m-YPAS scores of children who receive a sedative medication prior to surgery to the m-YPAS scores of children who receive a placebo. If the children who receive the sedative medication have significantly lower m-YPAS scores, this would provide evidence that the medication is effective in reducing preoperative anxiety. Similarly, the STAIC can be used to evaluate the effectiveness of psychological interventions, such as cognitive-behavioral therapy, in reducing anxiety in children.
8. Future Directions and Research Opportunities
Future research should focus on further refining and validating the m-YPAS and STAIC for use in diverse populations and settings. Studies are needed to examine the cultural and linguistic adaptability of these tools, ensuring that they are appropriate for use with children from different ethnic and cultural backgrounds. Research should also explore the use of these tools in combination with other assessment methods, such as physiological measures and parent reports, to obtain a more comprehensive picture of anxiety in children. Additionally, studies are needed to evaluate the long-term impact of preoperative anxiety on children’s health and well-being, and to identify effective interventions for preventing and managing preoperative anxiety.
8.1. Cross-Cultural Validation Studies
Cross-cultural validation studies are essential for ensuring that the m-YPAS and STAIC are valid and reliable measures of anxiety in children from different cultural backgrounds. Anxiety can manifest differently across cultures, and cultural factors can influence how children express and experience anxiety. Therefore, it is important to examine whether the m-YPAS and STAIC are sensitive to these cultural differences and whether the questionnaire items and behavioral anchors are interpreted similarly across cultures. Cross-cultural validation studies should involve children from diverse ethnic and cultural backgrounds, and should include both qualitative and quantitative methods to assess the cultural appropriateness of the tools. These studies can help ensure that the m-YPAS and STAIC are used appropriately and effectively in diverse populations.
8.2. Integrating Physiological Measures
Integrating physiological measures, such as heart rate variability, cortisol levels, and skin conductance, with the m-YPAS and STAIC can provide a more comprehensive assessment of anxiety in children. Physiological measures offer an objective and non-invasive way to assess anxiety levels, complementing the subjective measures obtained from the m-YPAS and STAIC. For example, a study might examine the relationship between m-YPAS scores, STAIC scores, and heart rate variability in children undergoing surgery. If children with high m-YPAS scores and high STAIC scores also have decreased heart rate variability, this would provide further evidence that these tools are valid measures of anxiety. Integrating physiological measures can also help to identify children who may be experiencing anxiety but not exhibiting overt behavioral signs or reporting subjective feelings of anxiety.
8.3. Longitudinal Studies on Long-Term Impact
Longitudinal studies are needed to examine the long-term impact of preoperative anxiety on children’s health and well-being. Preoperative anxiety has been linked to a number of negative outcomes, such as increased pain perception, prolonged recovery times, and behavioral problems post-surgery. However, little is known about the long-term consequences of preoperative anxiety, such as its impact on children’s mental health, academic performance, and social functioning. Longitudinal studies should follow children who experience preoperative anxiety over time, assessing their health and well-being at regular intervals. These studies can help to identify children who are at higher risk of experiencing long-term negative outcomes, and to develop effective interventions for preventing and managing preoperative anxiety.
9. Conclusion: Choosing the Right Tool for Assessment
In conclusion, both the m-YPAS and STAIC are valuable tools for assessing anxiety in children, each with its own strengths and limitations. The m-YPAS is an observational tool that is particularly useful for assessing anxiety in young children and for continuous monitoring of anxiety levels in the perioperative period. The STAIC is a self-report questionnaire that provides a direct measure of the child’s own experience of anxiety and is appropriate for older children who are able to provide reliable self-reports. The choice between the m-YPAS and STAIC depends on the specific goals of the assessment and the characteristics of the child being assessed. Healthcare providers should carefully consider the strengths and limitations of each tool when selecting an assessment method.
9.1. Summary of Key Findings
The key findings of the study comparing the m-YPAS and STAIC indicate that the m-YPAS is a reliable and valid tool for assessing anxiety in children. The m-YPAS demonstrated good to excellent inter-observer and intra-observer reliability, acceptable concurrent validity with the STAIC, and high construct validity. These findings support the use of the m-YPAS as a valuable tool for assessing anxiety in children in perioperative settings. The study also highlighted the importance of using multiple assessment methods, such as observational measures and self-report questionnaires, to obtain a more comprehensive picture of anxiety in children. By combining the strengths of different assessment methods, healthcare providers can improve their ability to identify and manage anxiety in children, thereby improving their overall health and well-being.
9.2. Implications for Clinical Practice
The implications of these findings for clinical practice are significant. Healthcare providers can use the m-YPAS to monitor anxiety levels in children in the preoperative holding area and during anesthesia induction, allowing them to identify children who may benefit from interventions to reduce anxiety. The STAIC can be used to screen children for anxiety prior to surgery, identifying those who may be at higher risk of experiencing preoperative anxiety. Both tools can be used to evaluate the effectiveness of interventions aimed at reducing anxiety, such as pharmacological interventions, psychological interventions, and environmental modifications. By using these tools in clinical practice, healthcare providers can tailor the care plan to meet the individual needs of each child, thereby improving their overall surgical experience.
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10. Frequently Asked Questions (FAQ)
1. What is preoperative anxiety in children?
Preoperative anxiety refers to the fear, worry, and distress experienced by children before, during, and after surgical procedures.
2. Why is it important to measure preoperative anxiety in children?
Measuring anxiety helps identify children at risk, allows for appropriate interventions, and monitors the effectiveness of treatments.
3. What is the Yale Preoperative Anxiety Scale (YPAS)?
The YPAS is an observational tool used to assess anxiety in children undergoing anesthesia induction, focusing on observable behaviors.
4. How does the Modified YPAS (m-YPAS) differ from the original YPAS?
The m-YPAS is adapted for use in the preoperative holding area, capturing a broader range of anxiety-related behaviors.
5. What is the State-Trait Anxiety Inventory for Children (STAIC)?
The STAIC is a self-report questionnaire that measures anxiety in children aged 9 to 12, assessing both state and trait anxiety.
6. What are the key strengths of the m-YPAS?
The m-YPAS allows for real-time assessment through direct observation and minimizes reliance on self-reporting.
7. What are the limitations of the m-YPAS?
The m-YPAS relies on subjective observer judgment and may not capture the full range of anxiety symptoms.
8. What are the advantages of using the STAIC?
The STAIC provides direct insight into a child’s anxiety and is a widely validated measure with extensive normative data.
9. What are the disadvantages of the STAIC?
The STAIC depends on the child’s ability to provide accurate self-reports and may be influenced by social desirability bias.
10. How can the m-YPAS and STAIC be used in clinical practice?
Both tools can monitor anxiety, screen children preoperatively, and evaluate the effectiveness of interventions, tailoring care plans for individual needs.
