Developments in RCADS scoring: combined gender option
This blog focuses on the Revised Child Anxiety and Depression Scale (RCADS). It discusses the combined gender option for calculating T-scores, which the measure developer has recently made available. To understand this new option, you may first appreciate a refresher on the background to RCADS T-scores to-date.
The background
T-scores
Scores on the subscales and total scales of the RCADS can be converted to T-scores. A T-score is a way of comparing a score to the scores of another group of people, called a ‘reference group’. This can help with interpreting a young person’s score.
For example, a T-score of 50 means that the score is the same as the average of the reference group. A T-score of 70 means that the score is high enough for there to be a very small percentage of people in the reference group with that score (or higher).
T-score thresholds
To aid interpretation, thresholds for T-scores have been suggested. The developers of the RCADS consider a T-score of 65 as a borderline clinical threshold and a T-score of 70 as a clinical threshold. T-scores on or above these thresholds may be described as ‘borderline clinical’ and ‘clinical’, respectively.
Reference groups
Reference groups consist of young people who completed the RCADS previously, for example as part of a research study. They are usually made up of young people of similar age and gender, given that symptoms of anxiety and depression appear differently depending on age and gender. The people asked to be part of reference groups do not need to be seeking support for their mental health.
The reference groups most widely used to convert RCADS scores to T-scores consist of young people in schools in Hawaii, United States, who completed the RCADS in 1998. For example, one of the reference groups for the RCADS social phobia subscale is 212 girls aged 9-10 (U.S. school grades 3rd and 4th).
Scoring programmes
The RCADS developers provide Excel scoring programmes to calculate subscale and total scores and convert those scores to T-scores. The newest scoring programme, called the ‘advanced scoring programme’ was released in 2024. It allows the selection of different reference groups by which to convert scores to T-scores. These include the most widely used reference groups, which are selected by choosing ‘Chorpita 2000’ as the data source. It also includes reference groups from data collected in other countries. At the time of writing, RCADS data for reference groups in the UK has not been collected.
What has changed?
Combined gender reference groups
The advanced scoring programme can convert a score from a particular subscale or total scale to a T-score using a reference group selected from one of 3 gender categories: female, male and combined. The combined option is a new addition that was not available in previous scoring programs. It allows a T-score to be calculated without taking gender into account.
For young people who do not identify as male or female, this may be more helpful than not being able to calculate a T-score, or having to choose a binary reference group to do so. However, this is not the same as having an option to select a gender diverse reference group (see ‘Gender diversity – Where next for RCADS’ below).
Selecting the female gender option will result in the same T-score as would be obtained if using an earlier scoring programme with the female gender option selected (or ‘girl’ as it was previously referred to). Likewise for the male gender option.
Selecting the combined gender option will result in a different T-score than that obtained from an earlier scoring programme. This is because a combined gender reference group for a given age range is the male and female reference groups for that age range added together.
Example
Three young people aged 12 complete the RCADS and all obtain a score of 15 on the social phobia subscale. Using the advanced scoring program, T-scores for social phobia are calculated for them using the widely used reference groups, by selecting the ‘Chorpita 2000’ data source.
Female gender is selected for the first young person, giving a T-score of 54. Combined gender is selected for the second young person, giving a T-score of 56. Male gender is selected for the third young person, giving a T-score of 60.
In this example, all three young people had the same score before conversion to a T-score. The T-score for the person selecting combined gender is higher than the T-score for the person selecting female gender, and lower than the T-score for the person selecting male gender. Although a similar pattern is seen in other examples, it is not always the case. The effect on the T-score of choosing the combined gender option depends on the particular subscale and the value of the score being converted.
What are the implications for practice?
If RCADS T-scores are used in considering the right support to offer young people, it is worth noting that the combined gender option will give a different T-score to the female/girl or male/boy gender options. In particular cases, this may result in a T-score falling on the other side of a threshold than it would have done if the female or male gender option was selected. Therefore, it may be helpful to consider the use of the combined gender option for specific young people, rather than all young people.
In using reference groups - or comparators for any measure, we would always advise you to think about how the comparison group is similar or different to the child or young person you are working with. Consider for example if there are differences, such as the time, the context, or their characteristics that might have influenced their experiences of anxiety or depression. You should use your professional judgement in interpreting any measure score.
Gender diversity: where next for RCADS?
The developers of the RCADS recognise that more work is needed to increase the inclusivity of reference groups beyond ‘female’, ‘male’ and ‘combined’. To explore this, they are interested in receiving RCADS data relating to groups of gender diverse young people. For further details please see the News section of the RCADS website.
Ben Ritchie, CORC Informatics Lead