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