Multidimensional Anxiety Scale for Children

2nd Edition–Self-Report
John S. March, M.D., MPH

Assessment Report

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This Assessment Report is intended for use by qualified assessors only, and is not to be shown or
presented to the respondent or any other unqualified individuals.
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MASC 2–SR Assessment Report for Jennifer L Admin Date: 10/09/2012

Introduction
The Multidimensional Anxiety Scale for Children 2nd Edition–Self-Report (MASC 2™–SR) is a
comprehensive assessment of anxiety dimensions in children and adolescents aged 8 to 19 years. The
MASC 2 indexes the range and severity of anxiety symptoms, and can be a useful adjunct to the diagnosis
of anxiety disorders. When combined with other valid sources of information, the MASC 2 can aid in the
early identification of anxiety-prone youth, as well as in monitoring treatment effects. This report provides
descriptive information about scale scores and outlines which scores may be indicative of anxiety symptoms
by comparing that individual’s scores to a norm group. Additional interpretive information is found in the
Multidimensional Anxiety Scale for Children 2nd Edition Manual (published by MHS).

This report is an interpretive aid and should not be provided to the parents, teachers, or youth, or used as
the sole basis for clinical diagnosis or intervention. Administrators are cautioned against drawing
unsupported interpretations. To obtain a comprehensive view of the individual, information from this report
should be combined with information gathered from other psychometric measures, interviews, observations,
and available records. This report is based on an algorithm that produces the most common interpretations

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of the obtained scores. Administrators should review responses to specific items to ensure that these
interpretations apply.

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Response Style Analysis

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The following section provides Jennifer L’s score on the Inconsistency Index.
Raw Score Guideline
4 The Inconsistency Index score does not indicate inconsistent response

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style.

T-score Guidelines

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The guidelines in the following table apply to all T-scores presented in this report.

T-score Guideline

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70+ Very Elevated
65–69 Elevated
60–64 Slightly Elevated
55–59 High Average
40–54 Average
<40 Low

Interpreting MASC 2 Scores

Responses on the MASC 2 are combined to create 11 T-scores: MASC 2 Total Score, Separation
Anxiety/Phobias, Generalized Anxiety Disorder (GAD) Index, Social Anxiety (Total, Humiliation/Rejection,
Performance Fears), Obsessions & Compulsions, Physical Symptoms (Total, Tense/Restless, Panic), and
Harm Avoidance. Higher T-scores indicate more severe and/or a greater number of symptoms. The MASC 2
Anxiety Probability score estimates the likelihood that a youth has one or more anxiety disorders based on
the number of Anxiety Scales (i.e., Separation Anxiety/Phobias, GAD Index, Social Anxiety: Total) that are
classified as at least Slightly Elevated (i.e., T-score ≥ 60).

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Overview of MASC 2 Scores

The following graphs display results from Jennifer L’s self-assessment and provide information about how
she compares to the normative group. Higher T-scores indicate more severe and/or a greater number of
symptoms. For the MASC 2 Anxiety Probability score, a higher score indicates a greater chance that the
youth has at least one anxiety disorder. Please refer to the MASC 2 Technical Manual for more information
about interpreting these results.

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Detailed Scores
The following tables summarize results from Jennifer L’s self-assessment and provide information about
how she compares to the normative group. Higher T-scores indicate more severe and/or a greater number
of symptoms. For the MASC 2 Anxiety Probability score, a higher score indicates a greater chance that the
youth has at least one anxiety disorder. Please refer to the MASC 2 Technical Manual for more information
about interpreting these results.

MASC 2 Total Score

Raw
Scale T-score Guideline
Score
MASC 2 Total Score 88 67 Elevated

MASC 2 Anxiety Probability Score

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Number of
Elevations on Probability Guideline

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Anxiety Scales
2 High There is a high probability that the youth has one
or more anxiety disorders.

MASC 2 Scales

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Raw
Scale T-score Guideline
Score
Separation

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20 73 Very Elevated
Anxiety/Phobias
GAD Index 15 61 Slightly Elevated

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Anxiety Scales Social Anxiety: Total 13 53 Average
Humiliation/Rejection 6 50 Average
Performance Fears 7 58 High Average

Obsessions & Compulsions 10 54 Average

Physical Symptoms:
Physical Symptoms 23 77 Very Elevated
Total
Panic 14 80 Very Elevated
Tense/Restless 9 68 Elevated
Harm Avoidance 22 62 Slightly Elevated

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Summary: Score Interpretation

The following section summarizes the results of Jennifer L’s self-assessment on the Multidimensional
Anxiety Scale for Children 2nd Edition–Self-Report (MASC 2–SR). Scores for each scale/subscale are
reported in this section, and include the obtained T-score. Higher scores indicate greater problems.
Interpretive guidelines are also provided. For scales/subscales with T-scores of 60 or higher (i.e., Slightly
Elevated or higher), this section also flags item-level elevations (if any) to provide more information about
the specific symptoms Jennifer L is experiencing. For scales/subscales with T-scores lower than 60 (i.e.,
High Average or lower), item-level information can be found in the Item Responses by Scale section of this
report.

Response Style Analysis

The Inconsistency Index score (raw score = 4) does not indicate an inconsistent response style.
MASC 2 Total Score
The MASC 2 Total Score indicates the overall extent to which Jennifer L is experiencing signs and

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symptoms of anxiety. Ratings on this scale yielded a T-score of 67, which falls within the Elevated score
range. This result indicates that overall, Jennifer L is likely experiencing an elevated number of anxiety
symptoms. An examination of all scale scores will identify the anxiety dimension(s) that are likely to be most

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problematic for Jennifer L.
MASC 2 Anxiety Probability Score

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The MASC 2 Anxiety Probability Score estimates the likelihood that the youth is experiencing one or more
anxiety disorders. Based on the profile of elevations on the Anxiety Scales (i.e., Separation Anxiety/Phobias,
GAD Index, and Social Anxiety), Jennifer L has a High probability of having one or more anxiety disorders.
Since the MASC 2 does not make formal diagnoses but instead indicates the probability of one or more

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diagnoses, other clinically relevant information should also be carefully considered in the assessment
process.
MASC 2 Scales

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MASC 2 Anxiety Scales
The Separation Anxiety/Phobias scale score reflects the extent to which Jennifer L is anxious about being
alone or scared of certain places or things. Ratings on this scale yielded a T-score of 73, which falls within

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the Very Elevated score range. Specifically, Jennifer L is scared or fearful of:
· Being away from her parents/family
· Not being near mom or dad
· Going away to camp
· Not having the light on at night
· Bad weather, the dark, animals or bugs
The GAD Index score reflects the extent to which Jennifer L may be experiencing symptoms similar to youth
diagnosed with Generalized Anxiety Disorder, including elevated worry about future events and associated
physical symptoms. Ratings on this scale yielded a T-score of 61, which falls within the Slightly Elevated
score range. Specifically, Jennifer L tends to:
· Excessively check things out first
· Feel tense
· Have trouble breathing
· Feel sick to her stomach
· Keep the light on at night
The Social Anxiety: Total scale comprises the following subscales: Humiliation/Rejection, which reflects
anticipation of embarrassment, and Performance Fears, which reflects anticipatory anxiety about being "on
stage" in a public or interpersonal context. Ratings on this scale yielded a T-score of 53, which falls within
the Average score range. Although the youth did not receive an elevated score on the Social Anxiety: Total
scale, an examination of the Humiliation/Rejection and Performance Fears subscale scores is
recommended.
The Humiliation/Rejection subscale score reflects the extent to which Jennifer L may be anxious about
being humiliated, embarrassed, or rejected by others in social settings. Ratings on this subscale yielded a T-
score of 50, which falls within the Average score range. No Humiliation/Rejection problems are indicated.

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The Performance Fears subscale score indicates the extent to which Jennifer L may be feeling anxious
about performing (e.g., public speaking, answering a teacher’s question in class) in public settings. Ratings
on this subscale yielded a T-score of 58, which falls within the High Average score range. No problems with
Performance Fears are indicated.
Obsessions and Compulsions
The Obsessions & Compulsions scale score reflects the extent to which Jennifer L may be experiencing
obsessive thoughts and/or engaging in compulsive behaviors that are consistent with a diagnosis of
Obsessive-Compulsive Disorder. Ratings on this scale yielded a T-score of 54, which falls within the
Average score range. No problems with Obsessions and Compulsions are indicated.
Physical Symptoms
The Physical Symptoms: Total scale comprises the following subscales: Panic and Tense/Restless.
Although physical symptoms alone are not predictive of anxiety disorders at the diagnostic level, they are
often targets for treatment. Ratings on this scale yielded a T-score of 77, which falls within the Very Elevated
score range. Examine the Physical Symptoms subscales (Panic and Tense/Restless) to identify the
dimension(s) that may be most problematic for Jennifer L.

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The Panic subscale score indicates the extent to which Jennifer L may be experiencing panic symptoms. If
these panic symptoms are unprovoked, then a formal diagnosis of panic disorder should be considered.
Ratings on this subscale yielded a T-score of 80, which falls within the Very Elevated score range.

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Specifically, Jennifer L is likely to:
· Feel sick to her stomach
· Have trouble breathing

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· Feel dizzy
· Have chest pains
· Have irregular heartbeats

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The Tense/Restless subscale score indicates the extent to which Jennifer L may be feeling tense, shaky,
jumpy, restless, or on edge. Ratings on this subscale yielded a T-score of 68, which falls within the Elevated
score range. Specifically, Jennifer L tends to:
· Feel tense or uptight

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· Be shaky or jittery
· Be jumpy

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Harm Avoidance
The Harm Avoidance scale score reflects the extent to which Jennifer L attempts to avoid negative
outcomes, wrongdoings, and/or dangers (e.g., experiential avoidance). Although harm avoidant behaviors
alone are not predictive of anxiety disorders at the diagnostic level, they often are important targets for
exposure-based treatments. Ratings on this scale yielded a T-score of 62, which falls within the Slightly
Elevated score range. Specifically, Jennifer L tends to:
· Do things to obey or please others
· Do things exactly right
· Check for potential danger

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Intervention Suggestions
The MASC 2 provides an easy way to identify anxiety and Obsessive-Compulsive Disorder (OCD)
symptoms and to develop a treatment plan that includes syndromal and item-level targets. This section
presents intervention suggestions for Jennifer L based on scale score elevations (i.e., T-scores ≥ 60) for the
Total Score, the Anxiety scales (i.e., Separation Anxiety/Phobias, GAD Index, Social Anxiety: Total), the
Obsessions & Compulsions scale, the Physical Symptoms: Total scale, and/or the Harm Avoidance scale.

Using the MASC 2 to Understand the Clinical Picture

This section provides general intervention suggestions for children and adolescents with elevated MASC 2
anxiety score(s). Children and adolescents who experience difficulty with anxiety usually have both
symptoms (something the youth experiences, such as worry) and signs (something that is visible, like
restlessness). Symptoms and signs extend across three key domains: cognitive, emotional, and behavioral.
The cognitive domain represents anxious thoughts and worries (such as “I am afraid to raise my hand in
class”); the emotional domain represents fearful feelings (such as fear manifested in physical sensations);

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and the behavioral domain, including avoidance of anxiety producing stimuli represents the physical effects
of anxiety (such as sweating or shakiness), reactive behaviors (such as distractibility associated with

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anxiety), or maladaptive ways of coping (such as experiential avoidance or family accommodation). Not
surprisingly, thoughts, feelings, behaviors and physical symptoms are strongly linked as follows:

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· Cognitive domain: When a youth encounters an anxiety-provoking stimulus, it is first cognitively
appraised as fearful—usually when one overestimates the risk (cognitive threat appraisal). The youth
then feels anxious and behaves in ways that reflect anxious thinking. For example, a youth who is
anxious about getting called on in class because his/her fear of rejection and humiliation might try to
keep a low profile to avoid the situation.

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· Emotional domain: A youth finds himself/herself in a context which is linked to the feeling of fear
(emotional threat appraisal). This feeling then drives anxious cognitions and behaviors. For example,
a youth who is already fearful in class may experience heart racing that leads to thoughts reflecting

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social anxiety, and so keeps a low profile.
· Behavioral domain: Behavior powerfully governs both emotional responses and thought. For
example, a youth who is already avoidant of settings in which he/she might have to speak up

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becomes increasingly fearful and avoidant in the classroom.
· By virtue of their unpleasantness, physical symptoms of anxiety are powerful problem maintaining
factors since they elicit avoidant behaviors and so negatively reinforce those same symptoms. For
example, a socially anxious youth feels nauseated and worries about getting called on in class, and
so tries to avoid getting noticed in part because of the fear of throwing up.

As noted, these symptoms and signs do not take place in a vacuum but rather are conditioned by the
youth’s environment. When a youth anticipates and responds to his/her environment, the environment
then responds back in a way that typically maintains the youth's anxiety by encouraging experiential
avoidance (avoiding things that make the youth anxious), which is a key feature of anxiety that is
captured on the MASC 2 Harm Avoidance scale. Families, peers, and teachers may also accommodate
the youth’s anxiety. Accommodation (e.g., providing reassurance, participating in avoidant behaviors,
doing tasks for the youth that he/she is capable of doing, or tolerating delays) is done to decrease the
youth’s distress which helps in the short term, but unintentionally reinforces avoidance and maintains
anxiety in the long run. With either experiential avoidance or accommodation, the anxiety disorder is
maintained by negative reinforcement, which is defined as the removal of a negative affect or behavior in
a way that perpetuates the signs and symptoms of anxiety. As a result, half to two-thirds of families with
children diagnosed with anxiety report hardship with siblings, marital discord, and/or school problems
related to the youth’s anxiety disorder. In addition, these signs and symptoms influence the youth’s
relationship with himself/herself and other people. Examination of the MASC 2 anxiety domains and
elevated items provides an overview of the individual youth's level of anxiety and also how the youth and
his or her environment cope with anxiety.
The Special Case of OCD

Many youth with OCD will also experience anxiety disorders, and a smaller number of youth with anxiety
disorders also will have OCD. Obsessions are persistent and intrusive thoughts, images, or impulses that

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also cause the youth significant anxiety or distress. Examples include thoughts about contamination, order
or symmetry, or harm to others. Compulsions are repetitive behaviors or mental acts that are performed in
order to prevent or reduce anxiety and distress. Common examples include hand washing, checking, and
counting. Similar to anxiety disorders, symptoms of OCD are established and maintained through negative
reinforcement. For example, a youth tries to avoid the triggers that provoke OCD; however, if he/she is
unable to do so, the youth performs the accompanying rituals as quickly as possible to get rid of the
dysphoric feelings and thoughts that define OCD. Families, peers, and teachers frequently accommodate to
the youth’s obsessions and compulsions. Accommodation (e.g., providing reassurance, participating in
rituals or avoidant behaviors, or doing tasks for the youth that he/she is capable of doing) is done to
decrease short term distress and improve functional outcomes. Accommodation, however, prevents the
youth from realizing that the stimuli behind his/her obsessions and compulsions are not real or threatening.
Consequently, intrusive thoughts, avoidance, and other reinforced behaviors are maintained.

The Rationale for Cognitive-Behavior Therapy

When considered together, the signs and symptoms identified on the
MASC 2 at the item level are like a pile of pickup sticks. Each color

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stick represents a specific anxiety syndrome like separation anxiety
or OCD. Each stick then represents a symptom or sign in
relationship to all the others in the pile. Some sticks are highly

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correlated and sit in close proximity; others are less closely related
and occur in decreased proximity.

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The clinician's task is to identify the sticks, note their relationship to each other, and pick them up in the
proper order. In relation to cognitive-behavior therapy, the clinician works with the youth to identify specific
targets by placing them on an exposure hierarchy (rated from most easily to resist, to most difficult) so that

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they can be approached rather than avoided. It is also important to understand target dependencies. For
example, a youth with both separation and social disorders may need to address public speaking anxiety
symptoms before going away to camp, so he/she can ask for help, if necessary.

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It is easy to see how anxiety becomes established and maintained through negative reinforcement (i.e.
experiential avoidance or accommodation). Unfortunately, doing so prevents the youth from realizing that

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the stimulus and anxiety themselves are not threatening. Consequently, anxious thoughts/feelings,
avoidance, and other reinforced behaviors are maintained. Successful treatment should therefore include
exposure to the feared stimulus in the absence of anxiety reducing behaviors (e.g., reassurance seeking or
behavioral avoidance) until the anxiety has diminished. As a result of successive exposure trials, the
relationship is broken between the stimulus, the anxious response, and accompanying problem-maintaining
behaviors. Symptoms are reduced, and distress and dysfunction are minimized. Although exposure, as a
behavioral intervention, is the key to success in treating anxious children and adolescents, cognitive
interventions are also helpful in confronting exaggerated probabilities of harm (e.g., something bad will
happen), costs (e.g., death) and over responsibility (e.g., it’s my fault since I didn’t do anything to prevent it).
Struggling with unruly fears by trying to suppress them may worsen the problem by increasing avoidance of
anxious thoughts and feelings thus making them more powerful and aversive. Mindfulness or acceptance
strategies (allowing situations to be present without a lot of reactivity) can be very helpful in minimizing
negative affectivity and in successfully completing an exposure task.

When OCD is present, exposure-based interventions take the form of exposure to OCD triggers and
obsessions while at the same time blocking rituals (response prevention) until the obsessions and
compulsions have diminished—a process termed exposure and response prevention. As a result of
successive Enhanced Relapse Prevention (ERP) trials, the relationship is broken between the stimulus, the
undesired response, and accompanying problem-maintaining behaviors. Symptoms are reduced, and
distress and dysfunction are minimized. Although ERP, as a behavioral intervention, is the key to success in
treating children and adolescents with obsessions and compulsions, cognitive interventions also can be
helpful in confronting exaggerated probabilities of harm (e.g., my failure to check the toaster will cause a
house fire), costs (e.g., the house will burn down and my family will be killed), and over responsibility (e.g.,
I’m responsible because I didn’t check the toaster). As with anxiety disorders, mindfulness or acceptance
strategies (allowing situations to be present without a lot of reactivity) can be very helpful in minimizing
negative affectivity and in successfully completing an exposure task.

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In summary, the MASC 2 identifies broad clusters of anxiety and/or obsessive-compulsive symptoms,
narrows the focus to specific signs and symptoms that are troubling the youth and family, and provides a
strong foundation for treatment planning using cognitive-behavioral approaches.

For a broad overview of childhood-onset mental disorders:

Kendall, P., & Comer, J. (2010). Childhood Disorders (2nd edition), London: Psychology Press.

Kendal, P., & Hedtke, K. (2006). Cognitive-Behavioral Therapy for Anxious Children: Therapist Manual,
Third Edition. Temple University, Philadelphia: Workbook Publishers.

Chorpita, B. (2007). Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders (Guides to
Individualized Evidence-Based Treatment). New York: Guilford Press.

Because many anxious children also have difficulties with depression and disruptive behavioral, a
modular multi-component approach may be useful:

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Chorpita, B., & Weisz, J. (2009). MATCH-ADTC: Modular Approach to Therapy for Children with Anxiety,
Depression, Trauma, or Conduct Problems. Satellite Beach, FL: PracticeWise Publications.

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The following books may be helpful in providing information on treating youth with Obsessive-
Compulsive Disorder.

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March, J., & Benton, C. (2007). Talking Back to OCD. New York: Guilford Press.

March, J., & Mulle, K. (1998). OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual.
New York: Guilford Press.

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For Administrator: This section of the report may be given to parents (caregivers) or to a third party upon parental
consent.

Multidimensional Anxiety Scale for Children 2nd Edition

Feedback Handout for Self-Report Ratings
Youth’s Name/ID: Jennifer L
Youth’s Age: 10 years
Date of Assessment: October 09, 2012
Assessor’s Name: Dr. H. W.
This feedback handout explains the child’s scores from ratings on the Multidimensional Anxiety
Scale for Children 2nd Edition–Self-Report (MASC 2–SR).
What is the MASC 2–SR?
The MASC 2–SR is a set of rating scales that is used to gather information about how the child is feeling. It

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mostly measures the feelings or thoughts that make the child nervous or anxious. The MASC 2–SR is based
on a test developed by Dr. John S. March, an expert in childhood anxiety disorders. Research has shown

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that the MASC 2–SR is reliable and valid.
Why do children complete the MASC 2–SR?
Information from the child about his or her own thoughts, feelings, and behaviors is extremely important,

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since the child is more aware of his/her feelings than anyone else. Self-reports provide invaluable
information about the child’s behavior (based on his or her own perceptions, feelings, and attitudes) that
parents may not know or be able to observe. The MASC 2–SR is usually used to better understand why the
child may be feeling nervous or anxious, so that a plan can be made to help him/her feel better. This

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information can also be used to see if the child’s treatment is helping. The MASC 2–SR is sometimes used
as a routine checkup, even if there is no reason to think that the child is having a problem with anxiety. If you
are not sure why the child was asked to take the MASC 2-SR, please ask the assessor listed at the top of
this form.

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How does the MASC 2–SR work?
Jennifer L read 50 statements that describe how she has been thinking, feeling, or acting recently, and rated

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how often those statements apply to her. Her ratings were then grouped together to see which kind of
situations or things she is most nervous about. Jennifer L’s choices were compared to those made by other
10-year-old females. These results show if Jennifer L is having more anxious feelings or thoughts than her
peers.
Results from the MASC 2–SR
The following section lists the areas covered by the MASC 2–SR. It also shows whether Jennifer L reported
average levels of anxiety, or if her ratings were higher than usual. If she got results that are different from
the standard results, a description is given to help her understand the difficulties she may be having.
Jennifer L may not have all of the problems in an area; she may have only some of the problems. Also,
please remember that high scores do not necessarily mean that Jennifer L has a serious problem or
requires treatment. MASC 2–SR scores must be considered with other information (for example, interviews
or other test results, and observations of the child) and be confirmed by a qualified clinician, before the
decision is made that a problem exists.
Overall Anxiety Symptoms
Jennifer L may be feeling more anxious about various situations and things than other people her age.
Probability of having an Anxiety Problem
Jennifer L’s score indicates that she has a High chance of having a problem with anxiety.
Anxiety Related to Being Alone
Jennifer L’s score was higher than average. Jennifer L may have reported feeling anxious about being alone
or away from her parents, particularly in unfamiliar situations or places.
Generalized Anxiety
Jennifer L’s score was higher than average. She may be generally anxious, signs of which include worrying,
being restless, and feeling sick.

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Anxiety about Being Humiliated or Rejected

Jennifer L’s score was average. She did not report being overly anxious about other people making fun of
her and/or thinking negatively about her.
Anxiety Related to Performing Publicly
Jennifer L’s score was average. She did not report being overly shy and/or worried about performing or
doing things in front of other people.
Intrusive Thoughts and Compulsive Behaviors
Jennifer L’s score was average. She did not report experiencing intrusive thoughts and compulsive
behaviors.
Panic
Jennifer L’s score was higher than average. She may be experiencing panic symptoms, which include:
shortness of breath, dizziness, chest pains, racing heart, stomach sickness, sweaty or cold hands, and
feelings of strangeness.
Feelings of Tension/Restlessness
Jennifer L’s score was higher than average. She may be tense, restless, jumpy, and shaky.

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Harm Avoidance Behaviors
Jennifer L’s score was higher than average. Jennifer L may be engaging in more harm avoidance behaviors

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compared to other people her age.

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