Screen for Child Anxiety Related Disorders (SCARED) - Parent Version

Screen for Child Anxiety Related Disorders (SCARED) - Parent Version

Screen for Child Anxiety Related Disorders (SCARED) - Parent Version

(To be filled out by the PARENT)
Patient Name:*
Parent Name:*
Today's Date:*

MonthDayYear
Date
Directions:
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 well as you can, even if some do not seem to concern you.
1. When my child feels frightened, it is hard for him/her to breathe.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
2. My child gets headaches when he/she is at school.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
3. My child doesn’t like to be with people he/she doesn’t know well.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
4. My child gets scared if he/she sleeps away from home.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
5. My child worries about other people liking him/her.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
6. When my child gets frightened, he/she feels like passing out.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
7. My child is afraid of being in crowded places.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
8. My child worries that he/she will do something embarrassing.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
9. When my child gets frightened, he/she feels dizzy.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
10. My child gets scared in social situations.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
11. My child worries about things working out for him/her.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
12. When my child gets frightened, he/she feels like he/she is going crazy.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
13. My child worries about how well he/she does things.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
14. My child is afraid of being away from me.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
15. When my child gets frightened, he/she feels like things are not real.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
16. My child is afraid of being alone in the house.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
17. My child worries about his/her future.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
18. My child is afraid of having anxiety (or panic) attacks.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
19. My child worries about how well he/she does at school.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
20. My child is scared to go to school.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
21. My child worries about things that have already happened.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
22. When my child gets frightened, he/she feels like he/she might not be able to breathe.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
23. My child has nightmares about something bad happening to his/her parents.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
24. My child worries about people laughing at him/her.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
25. When my child gets frightened, he/she feels like he/she is choking.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
26. My child worries about what is going to happen in the future.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
27. My child is afraid of being in places where there are a lot of people (like the mall, movie theaters, buses, etc.)*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
28. My child worries that something bad might happen to his/her parents.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
29. My child feels shy with people he/she doesn’t know well.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
30. My child worries about what others think of him/her.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
31. When my child gets frightened, he/she sweats a lot.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
32. My child is a worrier.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
33. My child often feels nervous.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
34. My child is afraid to be alone at home.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
35. My child is afraid of being in class when the teacher asks questions.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
36. My child is afraid of going to the doctor or dentist.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
37. My child is scared to go to bed alone.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
38. My child worries about being as good as other kids.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
39. When my child gets frightened, he/she feels like throwing up.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
40. My child worries about being away from home.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
41. My child worries that something bad might happen to him/her.*

0 = Not True or Hardly Ever True1 = Somewhat True or Sometimes True2 = Very True or Often True
Panic_Somatic_Score
Generalized_Anxiety_Score
Separation_Anxiety_Score
Social_Phobia_Score
School_Avoidance_Score
total_score
Your results:
- Panic/Somatic: {panic_somatic_score}
- Generalized Anxiety: {generalized_anxiety_score}
- Separation Anxiety: {separation_anxiety_score}
- Social Phobia: {social_phobia_score}
- School Avoidance: {school_avoidance_score}
- Total Score: {total_score}
Should be Empty: