Spence Preschool Anxiety Scale: Parent

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Today's Date* This field is required.

Date

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Child's Name* This field is required.

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Child's Date of Birth* This field is required.

Date

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Name of person filling the form:* This field is required.

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TOTAL SCORE (Interpret the score using the table below):

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	T-Score 60 (84th percentile)	T-Score 65 (94th percentile)	T-Score 70 (98th percentile)
All kids 6 and younger	34 and over	41 and over	48 and over

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DIRECTIONS: Next 28 items has statements that describe children. For each one, pick the response that best matches how your child typically behaves

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1. Has difficulty stopping him/herself from worrying.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

10

2. Worries that he/she will do something to look stupid in front of other people.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

11

3. Keeps checking that he/she has done things right(e.g., that he/she closed a door, turned off a tap).* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

12

4. Is tense, restless or irritable due to worrying.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

13

5. Is scared to ask an adult for help (e.g., a preschool or school teacher).* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

14

6. Is reluctant to go to sleep without you or to sleep away from home.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

15

7. Is scared of heights (high places).* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

16

8. Has trouble sleeping due to worrying.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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9. Washes his/her hands over and over many times each day.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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10. Is afraid of crowded or closed-in places.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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11. Is afraid of meeting or talking to unfamiliar people.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

20

12. Worries that something bad will happen to his/her parents.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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13. Is scared of thunder storms.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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14. Spends a large part of each day worrying about various things.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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15. Is afraid of talking in front of the class (preschool group)e.g., show and tell.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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16. Worries that something bad might happen to him/her(e.g., getting lost or kidnapped), so he/she won’t be able to see you again.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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17. Is nervous of going swimming.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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18. Has to have things in exactly the right order or position to stop bad things from happening.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

27

19. Worries that he/she will do something embarrassing in front of other people.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

28

20. Is afraid of insects and/or spiders.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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21. Has bad or silly thoughts or images that keep coming back over and over.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

30

22. Becomes distressed about your leaving him/her at preschool/school or with a babysitter.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

31

23. Is afraid to go up to group of children and join their activities.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

32

24. Is frightened of dogs.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

33

25. Has nightmares about being apart from you.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

34

26. Is afraid of the dark.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

35

27. Has to keep thinking special thoughts (e.g., numbers or words) to stop bad things from happening.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true

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28. Asks for reassurance when it doesn’t seem necessary.* This field is required.

Not true at all

Seldom true

Sometimes true

Quite often true

Very often true