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Reliability and validity of the Italian versions of the Children’s Fear Survey Schedule - Dental Subscale and the Modified Child Dental Anxiety Scale
Pubblication date: 19/2017
Authors: L. Paglia*, S. Gallus**, S. de Giorgio*, S. Cianetti***, E. Lupatelli***, G. Lombardo***, A. Montedori****, P. Eusebi****, R. Gatto*****, S. Caruso*****
Institution: *Department of Pediatric Dentistry, Italian Stomatologic Institute, Milan, Italy
**Department of Environmental Health Sciences, IRCCS
Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
***Surgical and Biomedical Sciences, Unit of Paediatric Dentistry, University of Perugia, Perugia, Italy
****Health Planning Service, Regional Health Authority
of Umbria, Perugia, Italy
*****Department of Life, Health and Environmental Sciences, Division of Implantology and Prosthetic Dentistry, Dental Clinic, University of L'Aquila, L'Aquila, Italy
Publication: European Journal of Paediatic Dentistry
Title: Reliability and validity of the Italian versions of the Children’s Fear Survey Schedule - Dental Subscale and the Modified Child Dental Anxiety Scale
Abstract: Aim Children’s dental fear and anxiety (DFA) causes significant problems in clinical practice. The 15-item Children’s Fear Survey Schedule - Dental Subscale (CFSS-DS) and the 8-item Modified Child Dental Anxiety Scale (MCDAS) are the most widely used measures of dental fear in children. The aim of this study is to examine the reliability and validity of the Italian versions of the CFSS-DS and MCDAS, also in comparison with a simple visual analogue scale (VAS).
Materials and methods The CFSS-DS and MCDAS were translated into Italian by a consensus panel of experts and administered to 210 dental patients aged 4–11 years from three Italian Institutions. Internal reliability was assessed using the Cronbach’s alpha correlation. A sub-sample of 60 children was selected for test-retest analysis. CFSS-DS and MCDAS, plus a VAS scale, rated both by children and parents, were validated using as gold standard the 4-item Frankl scale for behaviours assessed by dentists.
Results Mean CFSS-DS score was 30.8 (SD: 11.1) and mean MCDAS score was 17.9 (SD: 7.2), significantly higher among children aged 4-7 years and among children at their first dental visit. The alpha value for internal reliability was 0.90 (95%, CI= 0.88-0.92) for CFSS-DS and 0.87 (95% CI=0.85-0.90) for MCDAS. Both CFSS-DS and MCDAS showed good test-retest reliability (rsp= 0.80; p<0.001 for both scales). CFSS-DS and MCDAS predicted a Frankl score ≤2 (i.e., indicating children with an uncooperative behaviour) with a fair accuracy (AUC=0.69 and AUC=0.68, respectively). The VAS scale was more effective in predicting a negative behaviour (AUC=0.78). The scales self-reported by children were only slightly more accurate than those reported by parents.
Conclusions The Italian versions of the CFSS-DS and MCDAS are valid and reliable tools for the assessment of dental fear in Italian children aged 4–11 years. A simple, one-item VAS, and dental fear and anxiety evaluation by parents may be valid and quick alternatives to multi-item indices to predict an uncooperative children behaviour.