Scared Evaluation Form- Child Version

Screen for Child Anxiety Disorder (SCARED) Child Version
Child'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.

Rows	Not true or hardly ever true	Somewhat true or sometimes true	Very true or often true
1. When I feel frightened, it is hard to breathe
2. I get headaches when I'm at school
3. I don't like to be with people I don't know well
4. I get scared if I sleep away from home
5. I worry about other people liking me
6. When I get frightened, I feel like passing out
7. I am nervous
8. I follow my mother or father wherever they go
9. People tell me that I look nervous
10. I feel nervous with people I don't know well
11. I gets stomachaches at school
12. When I get frightened, I feel like I am going crazy
13. I worry about sleeping alone
14. I worry about being as good as other kids
15. When I get frightened, I feel like things are not real
16. I have nightmares about something bad happening to my parents
17. I worry about going to school
18. When I get frightened, me heart beats fast
19. I get shaky
20. I have nightmares about something bad happening to me
21. I worry about things working out for me
22. When I get frightened, I sweat a lot
23. I am a worrier
24. I get really frightened for no reason at all
25. I am afraid to be alone in the house
26. It is hard for me to talk with people I don’t know well
27. When I get frightened, I feels like I am choking
28. People tell me that I worry too much
29. I don't like to be away from his/her family
30. I am afraid of having anxiety (or panic) attacks
31. I worry that something bad might happen to my parents
32. I feel shy with people I don’t know well
33. I worry about what is going to happen in the future
34. When I get frightened, I feel like throwing up
35. I worry about how well I do things
36. I am scared to go to school
37. I worry about things that have already happened
38. When I get frightened, I feel dizzy
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)
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
41. I am shy

Should be Empty:

Screen for Child Anxiety Disorder (SCARED) Child Version