Revision and validation of Liebowitz Social Anxiety Scale for Children and Adolescents

doi:10.12122/j.issn.1673-4254.2026.03.22

Abstract

Abstract:

Objective To adapt the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) to Chinese cultural contexts and assess its reliability and validity among Chinese adolescents. Methods A total of 2103 vocational high school students (917 males and 1186 females; mean age 16.73±1.24 years) in Guangdong Province completed an online survey using the LSAS-CA. Item analysis and psychometric evaluations were conducted. The concurrent validity of the scale was assessed using the Social Anxiety Scale for Adolescents (SAS-A), Patient Health Questionnaire (PHQ-9), and Post-Event Processing Inventory-Trait (PEPI-T), and its discriminant validity was examined using the Rosenberg Self-Esteem Scale (RSES). Three months later, 210 of the students were retested to examine the test-retest reliability of LSAS-CA. Results The Chinese LSAS-CA retained 24 items (12 social interaction and 12 performance situations) for assessing anxiety and avoidance with a total of 48 scored responses. Confirmatory factor analysis was used for comparing fitting of 4 competing models (unidimensional, two-factor, bifactor, and higher-order models), and the bifactor model showed the best fit: anxiety bifactor model (χ²=3168.263, df=224, χ²/df=14.144, RMR=0.022, GFI=0.875, AGFI=0.832, PGFI=0.653, NFI=0.931, TLI=0.921, CFI=0.936, and RMSEA=0.079); avoidance bifactor model (χ²=3144.601, df=216, χ²/df=14.558, RMR=0.019, GFI=0.875, AGFI=0.826, PGFI=0.630, NFI=0.944, TLI=0.933, CFI=0.948, and RMSEA=0.080). Conclusion The revised Chinese version of LSAS-CA has acceptable reliability and validity in the context of Chinese culture and provides a more convenient measurement tool for Chinese researchers to study adolescent social anxiety.

Key words: social anxiety, adolescents, reliability and validity, model comparison, Liebowitz Social Anxiety Scale for Children and Adolescents

Zhijing SUN, Wei LI, Xinfeng TANG, Meng YU. Revision and validation of Liebowitz Social Anxiety Scale for Children and Adolescents[J]. Journal of Southern Medical University, 2026, 46(3): 686-692.

Figures/Tables 4

References 36

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Items	Fear or anxiety			Avoidance
Items	t	r	α	t	r	α
1. Talking to classmates or others on the telephone (S)	28.173	0.64	0.972	28.84	0.762	0.985
2. Participating in work groups in the classroom (P)	37.394	0.722	0.971	35.388	0.834	0.985
3. Eating in front of others (e.g., school cafeteria, restaurants) (P)	26.575	0.636	0.972	26.909	0.741	0.986
4. Asking an adult you don't know well, like a store clerk, principal, or policeman for help (e.g., for directions or to explain something that you don't understand) (S)	49.305	0.777	0.971	40.474	0.876	0.985
5. Giving a verbal report or presentation in class (e.g., show and tell for younger children) (P)	57.016	0.787	0.971	48.045	0.902	0.985
6. Going to parties, dances, or school activities (S)	59.135	0.784	0.971	49.427	0.889	0.985
7. Writing on the chalkboard or in front of others (P)	39.219	0.763	0.971	36.531	0.861	0.985
8. Talking with other kids you don't know well (S)	51.805	0.814	0.97	45.055	0.906	0.985
9. Starting a conversation with people you don't know well (S)	55.269	0.802	0.971	46.523	0.898	0.985
10. Using school or public bathrooms (P)	26.637	0.621	0.972	27.646	0.745	0.986
11. Going into a classroom or another place (e.g., Church, food court seating) when others are already seated (P)	47.399	0.785	0.971	40.977	0.869	0.985
12. Having people pay close attention to you or being the center of attention (e.g., your own birthday party) (S)	53.685	0.783	0.971	43.061	0.882	0.985
13. Asking questions in class (P)	53.079	0.817	0.97	44.174	0.892	0.985
14. Answering questions in class (P)	50.795	0.798	0.971	43.175	0.883	0.985
15. Reading out loud in class (P)	41.508	0.76	0.971	36.977	0.853	0.985
16. Taking tests (P)	37.448	0.663	0.972	32.197	0.784	0.985
17. Saying "no" to others when they ask you to do something that you don't want to do (like borrow something or look at your homework) (S)	39.821	0.749	0.971	37.116	0.848	0.985
18. Telling others that you disagree or that you are angry with them (S)	40.323	0.748	0.971	38.955	0.865	0.985
19. Looking at people you don't know well in the eyes (S)	51.666	0.792	0.971	43.992	0.867	0.985
20. Returning something in a store (S)	49.051	0.787	0.971	41.056	0.865	0.985
21. Playing a sport or performing in front of other people (e.g., gym class, dancing school recital, musical concert) (P)	63.654	0.783	0.971	49.927	0.877	0.985
22. Joining a club or organization (S)	49.208	0.805	0.971	43.151	0.879	0.985
23. Meeting new people or strangers (S)	53.616	0.816	0.97	44.885	0.888	0.985
24. Asking a teacher permission to leave the classroom (like to go to the bathroom or to the nurse) (P)	41.162	0.774	0.971	34.503	0.826	0.985

Items	Fear or anxiety			Avoidance
Items	t	r	α	t	r	α
1. Talking to classmates or others on the telephone (S)	28.173	0.64	0.972	28.84	0.762	0.985
2. Participating in work groups in the classroom (P)	37.394	0.722	0.971	35.388	0.834	0.985
3. Eating in front of others (e.g., school cafeteria, restaurants) (P)	26.575	0.636	0.972	26.909	0.741	0.986
4. Asking an adult you don't know well, like a store clerk, principal, or policeman for help (e.g., for directions or to explain something that you don't understand) (S)	49.305	0.777	0.971	40.474	0.876	0.985
5. Giving a verbal report or presentation in class (e.g., show and tell for younger children) (P)	57.016	0.787	0.971	48.045	0.902	0.985
6. Going to parties, dances, or school activities (S)	59.135	0.784	0.971	49.427	0.889	0.985
7. Writing on the chalkboard or in front of others (P)	39.219	0.763	0.971	36.531	0.861	0.985
8. Talking with other kids you don't know well (S)	51.805	0.814	0.97	45.055	0.906	0.985
9. Starting a conversation with people you don't know well (S)	55.269	0.802	0.971	46.523	0.898	0.985
10. Using school or public bathrooms (P)	26.637	0.621	0.972	27.646	0.745	0.986
11. Going into a classroom or another place (e.g., Church, food court seating) when others are already seated (P)	47.399	0.785	0.971	40.977	0.869	0.985
12. Having people pay close attention to you or being the center of attention (e.g., your own birthday party) (S)	53.685	0.783	0.971	43.061	0.882	0.985
13. Asking questions in class (P)	53.079	0.817	0.97	44.174	0.892	0.985
14. Answering questions in class (P)	50.795	0.798	0.971	43.175	0.883	0.985
15. Reading out loud in class (P)	41.508	0.76	0.971	36.977	0.853	0.985
16. Taking tests (P)	37.448	0.663	0.972	32.197	0.784	0.985
17. Saying "no" to others when they ask you to do something that you don't want to do (like borrow something or look at your homework) (S)	39.821	0.749	0.971	37.116	0.848	0.985
18. Telling others that you disagree or that you are angry with them (S)	40.323	0.748	0.971	38.955	0.865	0.985
19. Looking at people you don't know well in the eyes (S)	51.666	0.792	0.971	43.992	0.867	0.985
20. Returning something in a store (S)	49.051	0.787	0.971	41.056	0.865	0.985
21. Playing a sport or performing in front of other people (e.g., gym class, dancing school recital, musical concert) (P)	63.654	0.783	0.971	49.927	0.877	0.985
22. Joining a club or organization (S)	49.208	0.805	0.971	43.151	0.879	0.985
23. Meeting new people or strangers (S)	53.616	0.816	0.97	44.885	0.888	0.985
24. Asking a teacher permission to leave the classroom (like to go to the bathroom or to the nurse) (P)	41.162	0.774	0.971	34.503	0.826	0.985

Model	Structure	Fit Index
Model	Structure	χ²	DF	RMSEA	NFI	CFI	TLI	GFI
1	Fear Single-Factor	7046.394	252	0.113	0.847	0.852	0.838	0.751
	Avoidance Single-Factor	7844.161	252	0.120	0.861	0.865	0.852	0.717
2	Fear Two-Factor (Interaction, Performance)	3764.581	251	0.113	0.843	0.852	0.837	0.749
	Avoidance Two-Factor (Interaction, Performance)	4253.152	251	0.121	0.857	0.864	0.851	0.717
3	Fear Bifactor	3168.263	224	0.079	0.931	0.936	0.921	0.875
	Avoidance Bifactor	3144.601	216	0.080	0.944	0.948	0.933	0.875
4	Fear Higher-Order Factor	7115.609	253	0.114	0.846	0.850	0.837	0.750
	Avoidance Higher-Order Factor	7878.466	253	0.120	0.860	0.864	0.852	0.716

Model	Structure	Fit Index
Model	Structure	χ²	DF	RMSEA	NFI	CFI	TLI	GFI
1	Fear Single-Factor	7046.394	252	0.113	0.847	0.852	0.838	0.751
	Avoidance Single-Factor	7844.161	252	0.120	0.861	0.865	0.852	0.717
2	Fear Two-Factor (Interaction, Performance)	3764.581	251	0.113	0.843	0.852	0.837	0.749
	Avoidance Two-Factor (Interaction, Performance)	4253.152	251	0.121	0.857	0.864	0.851	0.717
3	Fear Bifactor	3168.263	224	0.079	0.931	0.936	0.921	0.875
	Avoidance Bifactor	3144.601	216	0.080	0.944	0.948	0.933	0.875
4	Fear Higher-Order Factor	7115.609	253	0.114	0.846	0.850	0.837	0.750
	Avoidance Higher-Order Factor	7878.466	253	0.120	0.860	0.864	0.852	0.716

Variable	Mean±SD	N	F/t	P
Gender
Male	79.63±31.45	917	-1.989	0.047
Female	82.32±30.23	1186
Grade
Grade 10	81.46±32.23	716	5.515	0.004
Grade 11	83.59±30.23	725
Grade 12	78.13±29.57	662
Only Child
No	79.85±30.38	426	-0.970	0.332
Yes	81.47±30.89	1677
Left-behind Experience
No	80.57±30.55	1886	2.526	0.012
Yes	86.14±32.43	217