Screen for Child Anxiety Related Disorders (SCARED) Parent Version
This form is to be filled out by the PARENT
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's Name
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First Name
Last Name
Parent's Name
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First Name
Last Name
This is to be completed by the PARENT. Below is a list of statements that describe how people feel. Read each statement carefully and decide if it is "Not True or Hardly Ever True", or "Somewhat True or Sometimes True" or "Very True or Often True" for your child. Then for each statement, fill in one circle that corresponds to the response that seems to describe your child for the last 3 months. Please respond to all statements as wellasyou can, even if some do not seem to concern your child.
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Rows
Not True or Hardly Ever True
Somewhat True or Sometimes True
Very True or Often True
1. When my child feel frightened, it is hard for them to breathe.
2. My child get headaches when they are at school.
3. My child doesn't like to be with people they don't know well.
4. My child gets scared if they sleep away from home.
5. My child worries about other people liking them.
6. When my child gets frightened, they feel like passing out.
7. My child is nervous.
8. My child follows me wherever I go.
9. People tell me my child looks nervous.
10. My child feels nervous with people they do not know well.
11. My child gets stomachaches at school.
12. When my child gets frightened, they feel like they are going crazy.
13. My child worries about sleeping alone.
14. My child worries about being as good as other kids.
15. When my child gets frightened, they feel like things are not real.
16. My child has nightmares about something bad happening to their parents.
17. My child worries about going to school.
18. When my child gets frightened, their heart beats fast.
19. My child gets shaky.
20. My child has nightmares about something bad happening to them.
21. My child worries about things working out for them.
22. When my child gets frightened, they sweat a lot.
23. My child is a worrier.
24. My child gets really frightened for no reason at all.
25. My child is afraid to be alone in the house.
26. It is hard for my child to talk with people they do not know well.
27. When my child gets frightened, they feel like they are choking.
28. People tell me that my child worries too much.
29. My child doesn't like to be away from their family.
30. My child is afraid of having anxiety or panic attacks.
31. My child worries that something bad might happen to their parents.
32. My child feels shy with people they don't know well.
33. My child worries about what is going to happen in the future.
34. When my child gets frightened, they feel like throwing up.
35. My child worries about how well they do things.
36. My child is scared to go to school.
37. My child worries about things that have already happened.
38. When my child gets frustrated, they feel dizzy.
39. My child feels nervous when they are with other children or adults and they have to do something while others watch them. (for example: read aloud, speak, play a game, play a sport.)
40. My child feels nervous when they are going to parties, dances, or any place where there will be people that they do not know well.
41. My child is shy.
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