RRL

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 17

Ashcraft (as cited in Thompson, Wylie and Hanna, 2016) defines mathematics anxiety

“as feelings of tension or fear that appear when a person is required to undertake a

mathematics performance task.”

Zakaira, Zain, Ahmad, and Erlina (2012) expressed pupils with high mathematics anxiety

levels exhibit negative thinking towards their abilities and capabilities. These students will

display less certainty working with numbers and numerical concepts and ideas through a critical

or problem solving process. A pupil who has a profound interest can be urged to work and train

without being asked by the teacher. The interest and confidence in this facet are vital in learning

to lessen the anxiety in mathematics and yet to acquire great outcomes on the assessment:

subsequently, influencing one's mathematics performance.

In educational settings, anxiety can have detrimental effects on learners. It involves

feelings in specific situations, such as examinations, as well as overall learning, and even

lifelong academic and vocational development. Along with more overarching anxiety disorders,

individuals may suffer from specific forms of test and performance anxiety that are connected to

a knowledge domain. Clearly, the most prominent of these disorders is math anxiety

(Luttenberger et al., 2018)

Baloglu and Kocak (2006) outlined three major factors that cause Mathematics anxiety,

namely, Dispositional, situational and environmental factors. The dispositional factors are

concerned with psychological and emotional features such as; attitudes towards Mathematics,

self-concept and learning styles. The self-concept refers to students’ perception of their own

ability to perform well in Mathematics and to learn new topics. The situational factors are direct

features that result from their particular Mathematics courses, the nature of the course, and how

it is designed and carried out, pace of instruction, etc. The environmental factors are
characteristics that affect the students prior to their Mathematics course; for instance, age,

gender, academic major, and previous Mathematics experience.

A negative attitude toward mathematics is a growing barrier for many children to

mathematics. For many children, negative attitudes toward mathematics begin early in life,

sometimes even before they enter kindergarten. The child’s educational context at home and at

school can affect this attitude (Scarpello et al., 2007).

The first years of elementary school are critical for learning basic mathematical skills.

Yet until recently the dominant view among educators and researchers alike was that math

anxiety only arose in the context of complex mathematics (e.g. algebra) and thus was not present

in young children. Math anxiety was thought to develop in junior high school, coinciding with

the increasing difficulty of the math curriculum towards the end of elementary school. Recent

research challenges this assumption. Not only do children as young as first grade report varying

levels of anxiety about math, which is inversely related to their math achievement, but this

anxiety is also associated with a distinct pattern of neural activity in brain regions associated

with negative emotions and numerical computations (Beilock et al.,, 2012)

Mathematics anxiety in elementary school students indicates that its onset coincides with

early years of schooling. This could in part be due to social learning from parents and teachers

with mathematics anxiety or negative perceptions of math. Parents or teachers might give

children mixed messages (Williams, 1988) about mathematics. They might emphasize how

highly difficult mathematics is and at the same time tell them how mathematics skills are of

essential importance for their future achievements.

Vann (1993) observed that mathematics anxiety in mothers was significantly predictive

of mathematics anxiety in children. This could be so for excessive expectations as well. Children
of parents with excessive expectations whose love and acceptance is conditional to how well

children live up to these expectations have high degree of anxiety. These circumstances might

lead to self-consciousness about one’s performance and to anxiety arising from not living up

high standards of parents. Children’s excessive self-critical attitude might cause anxiety

disproportionate to their failure in living up to these expectations. In fact, studies do show that

low self-esteem, confidence and efficacy are closely related to mathematics anxiety (Woodard et

al., 2004).

Children begin to construct the foundations for future mathematical concepts during the

first few months of life (Geist, 2003). Before a child can add or even count, they must construct

ideas about mathematics that cannot be directly taught. Many of these basic ideas are constructed

through interaction with the surrounding environment and the adults in that environment. Ideas

that will support formal mathematics later in life such as order and sequence, seriation,

comparisons, classifying, addition and other more advanced mathematical skills have their

genesis before the age of five. The seemingly simple understanding that numbers have a quantity

attached to them is actually a complex relationship that children must construct.

Math anxiety is a widespread, worldwide problem affecting all age groups.

Approximately 93% of adult US-Americans indicate that they experience some level of math

anxiety.4 Estimations are that approximately 17% of the US-American population suffers from

high levels of math anxiety.5 In a sample of adolescent apprentices in the United Kingdom,

approximately 30% of the study participants reported high math anxiety, and a further 18% were

at least somewhat affected by it.6 The most extensive set of data is provided by the Programme

for International Student Assessment (PISA) studies. In its 2012 assessments, across the 34

participating Organisation for Economic Co-operation and Development (OECD) countries, 59%
of the 15- to 16-year-old students reported that they often worry math classes will be difficult for

them; 33% reported that they get very tense when they have to complete math homework; and

another 31% stated they get very nervous doing math problems (Luttenberger et al., 2018).

Mathematics anxiety was found to affect the academic achievement in Mathematics of

the students. According to Karimi and Venkatesan, (2009), there is a relationship between

Mathematics anxiety, mathematics performance and academic hardness in high school students.

Their findings revealed that Mathematics anxiety has significant negative correlation with

Mathematics performance. They also reported a significant gender difference in Mathematics

anxiety. They also reported no significant difference between boys and girls in Mathematics

performance. They also suggest that the performance of students in Mathematics can be

influenced by Mathematics anxiety. Correlation between Mathematics anxiety and Mathematics

performance is a construct that attracts comments and researches. According to Pourmasleme et

al. (2013), a significant correlation was observed between high level anxiety and low academic

performance. Significant difference between males and females in Mathematics anxiety was also

reported.

Mathematics one of the core academic disciplines since it provides crucial foundational

skills and an important component of early learning for students. Mathematics aids children with

problem solving, measuring, developing their own spatial awareness, using and understanding

shapes.

According to the National Curriculum (1999), mathematics gives students a particularly

potent set of tools with which to understand and alter the world. These qualities include critical

thinking, problem-solving abilities, and the capacity for logical reasoning.


In addition, Lee (2006) states that mathematics engages and empowers us to take control

of various aspects of our lives. It is a creative discipline that is skillfully applied to communicate

accurately. Another way to think of mathematics is as a constantly developing web of ideas.

When a boxer’s corner man throws a white towel into the ring, the defeated boxer

surrenders. The beating must end and the boxer will be able to fight another day without major

injury. Most people understand the reference of tossing a white towel onto the floor as a sign of

giving up. Whether out of frustration or lack of self-confidence, the white towel is a symbol of

giving up and defeat. Frustration in mathematics often results in a similar outcome. “Seventy-

five percent of Americans stop studying math before they have completed the educational

requirements for their career or job” (Scarpello, 2007).

The important role of mathematics recognized Cockcroft (1986), for example, he writes:

“It would be very difficult – perhaps impossible – to live a normal life in very many parts of the

world in the twentieth century without making use of mathematics of some kind.” It would be

very difficult or not possible for a person to live on the earth in the 20th century without the

slightest utilize mathematics.

Mathematics Anxiety

From the study of Zakaria et al., (2012) reveals that there still exists mathematics anxiety

among secondary school students. However, gender-related factors do not influence mathematics

anxiety. This study also shows that there is a difference in mathematics achievement of students

based on their level of mathematics anxiety. Therefore, teachers should strive to understand

mathematics anxiety and implement teaching and learning strategies so that students can

overcome their anxiety.


Yuksel-Şahin (2008) suggests that teachers should be positive and supportive and should

also employ teaching methods that empower students to develop healthy attitudes toward

mathematics. In addition, Smith (2004) suggests that teachers demonstrate their own interest in

mathematics in order to raise students’ motivation in mathematics as a means of helping students

reduce their math anxiety. Thus, this study has implications for all parties, including teachers,

schools and parents, encouraging those with a vested interest in the success of their students to

take into account math anxiety levels before determining effective and appropriate strategies

when teaching and learning is carried out. In this way, it is hoped that the level of mathematics

anxiety can be reduced.

Potential Origins of Mathematical Anxiety

Mathematics anxiety can have multiple origins and, as noted by Shields (2005), can be

perpetuated in the home, society, and the classroom.

The home. In the home, parents who themselves suffer mathematics anxiety can

unintentionally transfer such anxiety to their children. In the context of doing mathematics, the

emotions expressed by one will inevitably and reciprocally shape the other within parent-child

interactions (Else-Quest, Hyde, & Hejmadi, 2008). For example, children who are reproached for

their errors may develop a fear of taking risks and exploring new possibilities, and may start

hating mathematics. Parental disappointment and despair are especially demoralizing due to the

value placed on the high positive regard of parents by children (Dossel, 1993), while parents

giving mathematics low status or applying pressure to children may also contribute to the

development of mathematics anxiety (Fraser & Honeyford, 2000). Stolpa (2004) also identifies

how parents may unintentionally raise mathematics anxiety in their children by providing them

with an excuse to stop trying when they are frustrated or upset due to difficulties with a
mathematical task. A response from parents, such as ‘Don’t worry, I’ve never understood

fractions’ or ‘Never mind, mathematics was always tricky for me at school too’, plants a seed

that may grow into a strong belief for children that they are incapable of learning mathematics.

High achievers are not immune to pressures from parents. Over-bearing parental pressure for

success or concern about the difficulty of mathematics for their children (Bernstein, Coté-

Bonanno, Reilly, Carver, & Doremus, 1995) may contribute to mathematics anxiety in high

achievers.

Society. Social factors such as mathematical myths may also induce or reinforce

mathematics anxiety for some students. For example, the myth that boys are better than girls in

mathematics and that only some people have a ‘mathematics mind’ can undermine positive self-

efficacy beliefs. Too often, situations are encountered in which it is ‘cool’ to hate mathematics,

with people readily stating, with some pride, ‘I’m no good at mathematics’, as though displaying

a badge of honour or promoting membership to the I Hate mathematics ‘Facebook’ group. As a

subject mathematics is unique as embarrassment often does not result from failure. A study

involving over 1000 undergraduate students in the United States affirms the view that failure at

mathematics is socially acceptable – the participants were less embarrassed in relation to lack of

mathematical skills compared with language skills (Latterell, 2005).

The classroom. Despite young children starting school having, for the most part, a well-

developed, informal competence in mathematics, it is apparent that the classroom is also a place

where mathematics anxiety can develop and flourish. Research studies (e.g., Vinson, 2001)

suggest that, in combination with the parental and societal factors, mathematics anxiety may

have its roots in teaching and teachers, with mathematics anxious teachers resulting in

mathematics anxious students at times. Teaching by mathematics anxious teachers is


characterized by an over-reliance on traditional instructional activities such as: drills, flash cards,

and work sheets; assigning the same work for everyone; teaching to the textbook; insisting on

only one correct way to complete a problem; concentrating more on basic skills rather than

concepts; and, whole class instruction (Gurganus, 2007). Despite New Zealand’s systemic

attempts to reform primary mathematics programmes (Higgins & Parson, 2009), we have ‘a long

tail of underachievement in mathematics’ (Neill, Fisher, & Dingle, 2010, p. 1) and traditional

ways of learning mathematics continue to be present within our schools (YoungLoveridge,

Taylor, Sharma, & Hāwera, 2006).

Mathematics Anxiety and Mathematics Achievement

Student performance is a concern for all educators and is an object of study that stands-

out in many research papers. Due the importance of mathematics, its achievement and

performance gained educators attention and has been an increasing field of study. There have

been several researchers who have discussed the issue of mathematics learning and the factors

influencing it. The factors identified as influencing the learning of mathematics can be divided

into two distinct groups: the demographic and psychographic factors (Alves et.al, 2012)

The findings of Zakaria et al., (2012) also showed significant differences between

students’ mathematics achievements based on their math anxiety levels. Students who are high

achievers have lower levels of anxiety, while low achieving math students have high levels of

anxiety. This is because high achievers have a strong understanding of mathematics and have

more confidence than low achievers. These findings support the findings of Woodard (2004) and

Karimi and Venkatesan (2009), who determined that students who have high anxiety levels tend
to earn lower mathematics scores. Conversely, students who have low levels of anxiety tend to

score higher in math.

In the study of Siebers (2015), A 12-item Math Questionnaire (MQ) was developed and

distributed to 381 middle school students in a northern Colorado middle school during the 2013-

2014 school year. Data from the Transitional Colorado Assessment Program (TCAP) during the

2012-2013 school year were used to compare mathematics achievement to mathematic anxiety.

Middle school grades consist of sixth, seventh, and eighth grade students who range in ages of 11

to 14 years old. Results from the quantitative study showed there were statistically significant

differences between mathematics anxiety and achievement on TCAP. Students who have high

mathematics anxiety tend to have low mathematics achievement. Other results showed that sixth

grade students had less mathematics anxiety than seventh grade students. Sixth grade students

had less mathematics anxiety compared to eighth grade students. Seventh grade students had a

higher level of mathematics anxiety compared to eighth grade students. Lastly, results showed

sixth grade students had the highest mathematics achievement across the middle school grades.

Eighth grade students showed the lowest mathematics achievement compared to sixth and

seventh grade.

Researchers have made efforts to examine individual differences in the relationship

between mathematics anxiety and mathematics achievement. The relationship between

Mathematics anxiety and mathematics achievement was studied by Ma and Jiangming Xub

(2004). Tocci & Engelhard (1991) found that students with a higher level of mathematics anxiety

perform at a lower level of mathematics achievement. Similarly, Hembree’s (1990) meta-

analysis reported an average correlation of -.34 between mathematics anxiety and mathematics

achievement. In a more recent meta-analytic review on the relationship between mathematics


anxiety and mathematics achievement, Ma (1999) found that the common population correlation

for this relationship is -.27. This magnitude was associated with a prediction that “measures (or

treatments) that resulted in the movement of a typical student in the group of high mathematics

anxiety in the group of low mathematics anxiety would be associated with improvement of the

typical student’s level of mathematics achievement from the 50th to the 71st percentile”.

Performance in Mathematics

Academic performance is an important result of all college co-curricular activities.

Grades and other aspects of classroom assessment influence student motivation to learn and

these provide students with information that they use in their learning (Brookhart, 2008). Many

aspects of college education are included in the totality of this performance whether sports and

cultural exercises of the university were also part of academic growth of all students. The

valuable perception of students on how they perceived their grades at the end of semester is a

partial overview of how they thought of their capability to perform and surpass all the challenges

of the course for a certain period or semester. Students demonstrated a conceptualization of

grading where effort should be weighted comparably to actual performance in importance to the

composition of a grade, with the expectation that grade allocation should reflect this perception

(Tippin, 2012).

The Math Anxiety Level of the Students. The anxiety level of a person is a behavioral

quality that should be quantified using psychological concepts. Thus, the expertise of two (2)

Psychology professors and a psychometrician was asked by the researcher in analyzing the data

pertaining to the anxiety of the students. Table 1.1 presents the level of math anxiety of the

respondents. Of the 88 respondents, 55 of them or 63% were identified with High Anxiety in

Pre- calculus and 12 respondents or 14% were diagnosed with Very High Anxiety. This resulted
to a total percentage of 77% or 67 respondents with anxiety in Pre- calculus. On the other hand,

only 5% or 5 respondents and 18% or 16 respondents were diagnosed with Very Low Anxiety

and Low Anxiety respectively. As a whole, only 23% of the respondents have lower math

anxiety or tolerable anxiety while overwhelmingly 77% have higher anxiety. These findings

mean that majority of the senior high school students of SSC, despite the fact that they are taking

the STEM strand, were diagnosed with high anxiety in Pre- calculus. This finding is possibly the

reason why most of these respondents were hesitant in participating classroom discussions in

their Pre- calculus subject. During the interview conducted by the researcher, certain symptoms

of math anxiety were observed. Likewise, these symptoms were also been observed during class

discussions whereby the researcher was also the teacher of the respondents. The behavioral

manifestations that had been observed by the researcher were: (1) lack of confidence to solve

mathematical problems when called by the teacher; (2) habitual tardiness and absences in

Precalculus subject; (3) Non- compliance to the course requirements of the subject ; (4) non-

submission of projects in Pre- calculus; (5) sweating palms and shaking voices when asked by

the teacher to explain a concept; and (6) Intentionally prioritizing other subjects more than Pre-

calculus (Estonato, 2017).

In another study, the value of math increased for middle school students when they had a

teacher whom they perceived to be high in support (Eccles, 1993). Maurillo (1999) undertook a

study on the assessment of grade five pupils’ mastery of the basic mathematics skills in the

division of Tacloban city. He revealed that the extent of mastery of the pupils in the different

mathematics skills was determined by the strategies, techiques, approaches, evaluative measures,

follow-up activities, and utilization of instructional materials employed by teachers.


Mathematics Anxiety and Demographic Factors

In the demographic factors gender is remarked as a factor that could explain differences

in academic performance. Since 1970s, gender has been investigated as a factor on which student

performance and attitude toward mathematics differ. It is a general perception that boys are

better at math than girls. However, studies on gender and mathematics show that the advantage

held by boys over girls in mathematics achievement has diminished markedly over the last 40

years and gender differences in mathematics achievement are no longer a relevant issue.

According to the same studies, research on gender and mathematics is often limited to the

relationship between gender differences in attitudes toward mathematics and gender differences

in mathematics achievement. However, the gender alone may not explain significant differences

in performance when viewed in the context of multiple types of mathematical knowledge (Alves

et.al, 2012)

One variable that has, over the years, received considerable attention in many studies on

science achievement in general and mathematics achievement in particular is gender. In a meta –

analysis of 77 studies conducted between 1980 and 1991 among middle and high school

students, DeBaz (1994) found a significant gender effect favoring males in overall science

achievement. Hedges and Newell (1999) discovered that boys outperform girls in science but in

reading and writing girls have the advantage. Researchers have indicated that gender affects

mathematics achievement. For example, Trends in International Mathematics and Science Study

(TIMSS), found significant differences between male and female students in mathematics

achievement, with male students significantly outperforming their female counterparts.


Predictors of Mathematics Achievement

Several studies have been conducted over the years to determine the predictors of

mathematics achievement among various groups of individuals. Some of the predictors

discovered are: socio- economic status (Ajayi et al., 2011), students’ employment status

(Wantanabe, 2005), teaching methods (Eniayeju, 2010), gender and continuous assessment

(Owolabiet al., 2009). Other factors found to affect achievement in mathematics are: self-concept

and learning style (Rech & Stevens, 1996), reading abilities, mathematics self-efficacy and

teacher evaluation (Larwin, 2010) and students’ previous knowledge (Siegler et al., 2012).

Students who have mathematics anxiety especially females seem to enjoy less in learning

mathematics process and they will lack of confidence with their abilities in mathematics. Gender

differences in mathematics have long been explained as deficits, particularly inferior spatial

visualization among girls (Collins et al., 1997). Some presume this to be a sex-linked

characteristic of females. Justification for this point of view is often based on deficits found in

boys, such as higher levels of reading disabilities and attention deficit disorders, as well as the

superiority of males on spatial tests (Nass, 1993; Nordvik & Amponsah, 1998). As a result,

innate differences have long been used to explain the performance gap between the sexes. A

report by the American Association of University Women (1992) blames achievement

differences on differential treatment of girls in the classroom, curricula that either ignores or

stereotypes women, and gender bias that undermines girls' self-esteem.

Mitigating Math Anxiety


Current reforms in mathematics education that put the ‘spotlight squarely on the social

and cultural aspects of mathematical development’ (Walshaw et al., 2008) require teachers to

ensure that all students have opportunities to develop mathematical proficiency that includes a

positive mathematical disposition. As math anxiety is a learned condition (Nolting, 2011), one

hopes it can be unlearned. Consequently, teachers have an important role in the reduction or

prevention of student math anxiety. The research literature points to several promising ways

teachers can assist in the unlearning, or even prevention, of math anxiety in students. The variety

of ways available to teachers discussed here include: building positive attitudes towards

mathematics; utilizing journal writing, autobiography, metaphors, drawing, thought bubble

pictures, bibliotherapy, and math related fiction books; promoting an appropriate classroom

culture; utilizing effective teaching practices; working to reduce one’s own math anxiety; and,

involving parents in school mathematics.

To begin, the need to attend to the affective needs of students is discussed. Because

emotions drive and intensify thinking in mathematics in profound and powerful ways,

identifying students’ emotions concerning mathematics is as important as identifying any

cognitive skill (Zambo et al., 2006). There is a range of ways in which teachers might first

identify student emotions before bringing them out into the open through a classroom discussion

of math anxiety. Journal writing, while typically utilized to create opportunities for students to

express their understandings of mathematical concepts, can also be used for sharing and

reflecting on feelings about, and experiences with mathematics (Furner et al., 2003).

Autobiographies (Ellsworth et al., 2000) in which students are encouraged to explain their

personal mathematics background in writing, including family experiences of mathematics, may

also provide students with the opportunity to express their feelings about mathematics.
The most widely cited scale used to measure and explore mathematics anxiety is the

Mathematics Anxiety Rating Scale (MARS) (Suinn, 1972). Researchers suspected that some

individuals who did not normally suffer from general anxiety were still affected by mathematics

anxiety, so Suinn developed the MARS to look more specifically at mathematics anxiety. The

purpose of the MARS was to help researchers explore mathematics anxiety and to evaluate

mathematics-anxiety relief techniques.

On the other hand, a questionnaire was developed with items addressing students’

perceptions of their self-efficacy in mathematics and their feelings of anxiety toward

mathematics with respect to various aspects of learning mathematics in college. The

Mathematics Self-Efficacy and Anxiety Questionnaire (MSEAQ) fits my study and majority of

the items came from a pilot version, which was developed to provide college mathematics

instructors and mathematics education researchers with information about students’ self-efficacy

in their ability to learn mathematics (May et al., 2008). For the pilot version, a large pool of

items was generated that addressed both the mathematics self-efficacy and mathematics anxiety

of college students.

These items were based on the research literature, and some of them were adapted from

previous questionnaires designed to measure mathematics self-efficacy (Betz & Hackett, 1983),

mathematics anxiety (Richardson & Suinn, 1972), and science self-efficacy and science anxiety

(Glynn et al., 2007). The items chosen for the final version of the MSEAQ also took into account

college mathematics instructors’ input regarding their experiences with college students’ self-

efficacy and anxiety.

For many people, math anxiety is an issue. It can happen at any educational level, from

elementary school to college, and once it's established, it can continue throughout life,
obstructing further arithmetic study and everyday activities involving numeracy (Oxford &

Vordick, 2006).

Mathematics test anxiety, numerical anxiety, and abstraction anxiety are the three

subtypes of mathematics anxiety. Before, during, and after performing mathematical activities,

people experience test anxiety related to mathematics. When performing fundamental operations

or a mixture of these operations, numerical anxiety occurs. When working with mathematical

concepts and properties to solve equations, algebraic notations or symbols, and abstraction

anxiety can arise (Morada, 2015).

Even more surprising is the possibility that there may not be a consistent relationship

between teacher anxiety and student progress for all students and teachers. Youths are more

inclined than adults of the opposite gender to model their actions and attitudes after them. One

could anticipate seeing a correlation between teacher anxiety and both boys' and girls' math

achievement given that Beilock (2010) claimed that teachers who are very concerned about

arithmetic are worse math teachers. However, research appears that math teachers who exhibit

high levels of math anxiety are directly affecting girls' math ability through influencing girls'

gender-related perceptions about who is capable of mastering arithmetic.

Smail (2017) used Bayesian study to find a strong correlation between mathematics fear

and gender, personality type, and study habits. According to him female learners are more likely

than male to undergo mathematical anxiety, feel comfortable learning mathematics, and have
regular study habits. Recognizing elements of learners' In order to meet the demands of math-

phobic students, it is important to consider their gender, personality types, and study habits.

Part II is the mathematics anxiety rating scale which will determine the level of

mathematical anxiety of respondents. The Mathematics Self-Efficacy and Anxiety Questionnaire

(MSEAQ), a 29-item questionnaire checklist developed by May (2009) which has a very good

internal consistency (Cronbach’s coefficient alpha = 0.94). It consists of 29 statements. The 15

statements on anxiety will be used to determine the level of mathematics anxiety of the

respondents. The items were based on the research literature, and some of them were adopted

from previous questionnaires designed to measure mathematics self-efficacy (Betz & Hackett,

1983), mathematics anxiety (Richardson & Suinn, 1972), and science self-efficacy and science

anxiety (Glynn, Taasoobshirazi, & Brickman, 2007).

Carey et al., (2017) adapted the Abbreviated Math Anxiety Scale (AMAS) to be utilized with British
leraners aged 8 to 13. They evaluate the scale's reliability, factor structure, and divergent validity in their
study. The modified AMAS (mAMAS) was given to a large group of British children and adolescents (n =
1746). Factor analysis of the mAMAS confirmed that it has the same underlying factor structure as the
original AMAS, with subscales measuring anxiety about Learning and Evaluation in math. The mAMAS
provides a valid and reliable scale for measuring MA in children and adolescents, from a younger age
than is possible with the original AMAS.

You might also like