Scared Evaluation Form- Parent Version

Screen for Child Anxiety Disorder (SCARED) Parent Version
Child's Name

First NameLast Name
Parent's Name

First NameLast Name
Date

MonthDayYear

Below is a list of sentences of how people feel. Read each phrase and decide if it is "Not true or hardly ever true", "Somewhat true or sometimes true",Very true or often true" for you.

	Not true or hardly ever true	Somewhat true or sometimes true	Very true or often true
1. When my child feels frightened, it is hard for him/her to breathe
2. My child gets headaches when he/she is at school
3. My child doesn’t like to be with people he/she doesn’t know well
4. My child gets scared if he/she sleeps away from home
5. My child worries about other people liking him/her
6. When my child gets frightened, he/she feels like passing out
7. My child is nervous
8. My child follows me wherever I go
9. People tell me that my child looks nervous
10. My child feels nervous with people he/she doesn’t know well
11. My child gets stomachaches at school
12. When my child gets frightened, he/she feels like he/she is going crazy
13. My child worries about sleeping alone
14. My child worries about being as good as other kids
15. When he/she gets frightened, he/she feels like things are not real
16. My child has nightmares about something bad happening to his/her
parents
17. My child worries about going to school
18. When my child gets frightened, his/her heart beats fast
19. He/she gets shaky
20. My child has nightmares about something bad happening to him/her
21. My child worries about things working out for him/her
22. When my child gets frightened, he/she sweats 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 he/she doesn’t know well
27. When my child gets frightened, he/she feels like he/she is choking
28. People tell me that my child worries too much
29. My child doesn’t like to be away from his/her family
30. My child is afraid of having anxiety (or panic) attacks
31. My child worries that something bad might happen to his/her parents
32. My child feels shy with people he/she doesn’t know well
33. My child worries about what is going to happen in the future
34. When my child gets frightened, he/she feels like throwing up
35. My child worries about how well he/she does 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 frightened, he/she feels dizzy
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)
40. My child feels nervous when he/she is going to parties, dances, or any place where there will be people that he/she don't know well
41. My child is shy

Should be Empty:

Screen for Child Anxiety Disorder (SCARED) Parent Version