SCARED for Child SCARED for Child SCARED (for Child) Email to receive your copy (Optional) Confirm Email to receive your copy (Optional) Enter a confirmation email address. Date * Child's Name * Parent's Name * CHILD to Complete. Check the appropriate response. 1. When I feel frightened, it is hard to breathe. * Hardly ever or not true Sometimes true Often or always true 2. I get headaches when I am at school. * Hardly ever or not true Sometimes true Often or always true 3. I don’t like to be with people I don’t know well. * Hardly ever or not true Sometimes true Often or always true 4. I get scared if I sleep away from home. * Hardly ever or not true Sometimes true Often or always true 5. I worry about other people liking me. * Hardly ever or not true Sometimes true Often or always true 6. When I get frightened, I feel like passing out. * Hardly ever or not true Sometimes true Often or always true 7. I am nervous. * Hardly ever or not true Sometimes true Often or always true 8. I follow my mother or father wherever they go. * Hardly ever or not true Sometimes true Often or always true 9. People tell me that I look nervous. * Hardly ever or not true Sometimes true Often or always true 10. I feel nervous with people I don’t know well. * Hardly ever or not true Sometimes true Often or always true 11. I get stomachaches at school. * Hardly ever or not true Sometimes true Often or always true 12. When I get frightened, I feel like I am going crazy. * Hardly ever or not true Sometimes true Often or always true 13. I worry about sleeping alone. * Hardly ever or not true Sometimes true Often or always true 14. I worry about being as good as other kids. * Hardly ever or not true Sometimes true Often or always true 15. When I get frightened, I feel like things are not real. * Hardly ever or not true Sometimes true Often or always true 16. I have nightmares about something bad happening to my parents. * Hardly ever or not true Sometimes true Often or always true 17. I worry about going to school. * Hardly ever or not true Sometimes true Often or always true 18. When I get frightened, my heart beats fast. * Hardly ever or not true Sometimes true Often or always true 19. I get shaky. * Hardly ever or not true Sometimes true Often or always true 20. I have nightmares about something bad happening to me. * Hardly ever or not true Sometimes true Often or always true 21. I worry about things working out for me. * Hardly ever or not true Sometimes true Often or always true 22. When I get frightened, I sweat a lot. * Hardly ever or not true Sometimes true Often or always true 23. I am a worrier. * Hardly ever or not true Sometimes true Often or always true 24. I get really frightened for no reason at all. * Hardly ever or not true Sometimes true Often or always true 25. I am afraid to be alone in the house. * Hardly ever or not true Sometimes true Often or always true 26. It is hard for me to talk with people I don’t know well. * Hardly ever or not true Sometimes true Often or always true 27. When I get frightened, I feel like I am choking. * Hardly ever or not true Sometimes true Often or always true 28. People tell me that I worry too much. * Hardly ever or not true Sometimes true Often or always true 29. I don’t like to be away from my family. * Hardly ever or not true Sometimes true Often or always true 30. I am afraid of having anxiety (or panic) attacks. * Hardly ever or not true Sometimes true Often or always true 31. I worry that something bad might happen to my parents. * Hardly ever or not true Sometimes true Often or always true 32. I feel shy with people I don’t know well. * Hardly ever or not true Sometimes true Often or always true 33. I worry about what is going to happen in the future. * Hardly ever or not true Sometimes true Often or always true 34. When I get frightened, I feel like throwing up. * Hardly ever or not true Sometimes true Often or always true 35. I worry about how well I do things. * Hardly ever or not true Sometimes true Often or always true 36. I am scared to go to school. * Hardly ever or not true Sometimes true Often or always true 37. I worry about things that have already happened. * Hardly ever or not true Sometimes true Often or always true 38. When I get frightened, I feel dizzy. * Hardly ever or not true Sometimes true Often or always true 39. I feel nervous when I am with other children or adults and I have to do something while they watch me (for example: read aloud, speak, play a game, play a sport.) * Hardly ever or not true Sometimes true Often or always true 40. I feel nervous when I am going to parties, dances, or any place where there will be people that I don’t know well. * Hardly ever or not true Sometimes true Often or always true 41. I am shy. * Hardly ever or not true Sometimes true Often or always true If you are human, leave this field blank. Submit
