CYP SEMH, RCADS Screening and Support Profile (SRSSP™)

CYP SEMH, RCADS Screening and Support Profile (SRSSP™)

This form screens for emotional wellbeing and areas of neurodivergent need.It includes standardised domains (based on the Revised Children’s Anxiety and Depression Scale – RCADS) and supplementary indicators for sensory, executive, and social-emotional functioning.This is not a diagnostic tool, but may support referrals, reasonable adjustments, or requests for further assessment.
Full Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Gender
Name Of The Person Who Completed this form

First NameLast Name
Relationship to Child/Young Person
Email (for results)
example@example.com
Date of completion

DayMonthYear
Date
This is a wellbeing screening tool. It includes questions about how you think, feel, and react in different situations. There are no right or wrong answers.

Your answers help adults understand how to support you better—at home, at school, or elsewhere. You can choose not to answer any question that makes you feel uncomfortable.
Section 1: Emotional Wellbeing
I worry a lot about different things
I feel sad or like I don't enjoy anything
When something is bothering me, my body feels tight or uncomfortable
I get really upset if I think I’ve messed something up
I feel scared being home alone
Things that used to be fun don’t feel fun anymore
I feel nervous before tests or being judged on my work
I worry that people are annoyed or angry with me
I feel upset being away from home or my safe people
I get stuck with unwanted thoughts or pictures in my head
I find it hard to fall asleep or stay asleep
I worry about not doing well at school
I get scared something bad might happen to someone I love
I feel like I can’t breathe, even when I’m not doing anything active
I don’t feel like eating or I eat too much when I’m stressed
I check things a lot (like doors or switches) to make sure they’re done
I feel scared sleeping alone
I find it hard to go to school because of how I feel
I don’t feel like doing anything, even things I usually like
I try to avoid things where I might look silly or get it wrong
I feel tired a lot, even when I’ve slept
I worry that something bad will happen to me
I keep thinking the same things over and over, even when I don’t want to
My heart races when I feel nervous
It’s hard to think clearly when I’m upset
I shake or tremble when I’m scared
I get scared that something bad might happen
My body feels shaky when I’m nervous
I feel like I’m not good enough
I get really worried about making mistakes
I think of special numbers, words, or routines to stop bad things from happening
I worry a lot about what other people think of me
I feel trapped or panicked in crowded places
I suddenly feel really scared for no reason
I worry a lot about the future
I feel dizzy or lightheaded when I’m anxious
I think about dying or not being here
I feel scared speaking in front of the class or a group
My heart beats really fast for no reason
I feel like I don’t want to do anything or move
I worry that I’ll suddenly feel scared even when nothing’s wrong
I have to do some things over and over to feel better (like cleaning or lining things up)
I worry I’ll look silly or make a mistake in front of people
I have to do some things in a certain way to feel safe
I worry a lot when I’m trying to fall asleep
I would feel scared staying overnight somewhere without family
I feel restless or like I need to move all the time
Section 2: Supplementary Neurodivergent Needs
Bright lights, loud sounds, or busy places make me feel overwhelmed
Clothes, textures, or smells really bother me
I avoid places or tasks that feel too uncomfortable
It’s hard for me to start tasks—even ones I want to do
I lose track of what I’m doing or forget what comes next
I struggle to organise things like homework, time, or my space
I try to hide how I feel so I seem “normal” or don’t stand out
After being around people, I feel tired, shut down, or need time alone
I hold in my feelings all day and then have a meltdown or shutdown later
Little problems feel really big when I’m already stressed or tired
I feel like I swing between doing everything and doing nothing
I feel worn out a lot, even when I haven’t done much
RCADS © 2000 by Bruce F. Chorpita. Used with permission for educational and clinical purposes. Not for resale. Incorporated within the SRSSP™ as part of a wider support profile.
© ABC Mental Health Support Ltd
This form is the intellectual property of ABC Mental Health Support Ltd and must not be copied, distributed, or reproduced without prior written permission. For licensed use, please contact ABC Mental Health Support Ltd.
For Clinician Use Only
Major Depression
Generalised Anxiety Disorder
Separation Anxiety
Social Phobia
Panic Disorder
OCD
Masking and Social Fatigue
Executive Functioning
Burnout and Emotional Regulation
Total Score
Score Interpretation & Thresholds
The following thresholds are based on the original RCADS guidelines (Chorpita et al., 2000) and adapted for school-age populations. They indicate potential concern and should be used alongside professional judgment and contextual understanding.

Major Depression (10 items)

0–10 = Low
11–20 = Moderate
21–30 = High

Generalised Anxiety (8 items)

0–8 = Low
9–16 = Moderate
17–24 = High

Separation Anxiety (6 items)

0–6 = Low
7–12 = Moderate
13–18 = High

Social Phobia (7 items)

0–7 = Low
8–14 = Moderate
15–21 = High

Panic Disorder (10 items)

0–10 = Low
11–20 = Moderate
21–30 = High

Obsessive-Compulsive (7 items)

0–7 = Low
8–14 = Moderate
15–21 = High

A score in the 'High' range may indicate significant difficulties consistent with the diagnostic criteria for depressive disorders, anxiety disorders, separation anxiety disorder, panic disorder, or OCD. However, this tool is not a diagnostic assessment. High scores should be used to guide further clinical inquiry, support planning, referrals, or statutory assessments (e.g., EHCP evidence, CAMHS referrals).

Key References
Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research and Therapy, 38(8), 835–855. https://doi.org/10.1016/S0005-7967(99)00130-8
Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour Research and Therapy, 43(3), 309–322. https://doi.org/10.1016/j.brat.2004.02.004
Ebesutani, C., Bernstein, A., Nakamura, B. J., Chorpita, B. F., & Weisz, J. R. (2010). A psychometric analysis of the Revised Child Anxiety and Depression Scale—Parent Version in a clinical sample. Journal of Abnormal Child Psychology, 38(2), 249–260. https://doi.org/10.1007/s10802-009-9363-8
Weisz, J. R., Chorpita, B. F., Frye, A., Ng, M. Y., Lau, N., Bearman, S. K., ... & Hoagwood, K. E. (2011). Youth top problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal of Consulting and Clinical Psychology, 79(3), 369–380. https://doi.org/10.1037/a0023307
NICE. (2019). Social, emotional and mental wellbeing in primary and secondary education (NICE guideline [NG223]). National Institute for Health and Care Excellence. Retrieved from https://www.nice.org.ukeview, 17(1), 67–84.

Additional Neurodivergent Domains (SRSSP™)
The following domains are included to capture needs often under-represented in traditional SEMH/RCADS tools. These sections are not diagnostic but provide a structured profile of strengths and challenges to guide support planning. Thresholds reflect relative levels of need and should be interpreted with professional judgment.

Executive Functioning

0–5 = Low difficulty
6–10 = Moderate difficulty
11–15 = High difficulty

Sensory Processing

0–5 = Low need
6–10 = Moderate need
11–15 = High need

Masking & Camouflaging

0–5 = Low impact
6–10 = Moderate impact
11–15 = High impact

Autistic Burnout / Emotional Exhaustion

0–5 = Low risk
6–10 = Moderate risk
11–15 = High risk
ABC Mental Health Support Ltd is registered with the Information Commissioner’s Office (ICO) and fully complies with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018. All personal data is collected, processed, and stored lawfully, securely, and confidentially.
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CYP SEMH, RCADS Screening and Support Profile (SRSSP™)

This is a wellbeing screening tool. It includes questions about how you think, feel, and react in different situations. There are no right or wrong answers.

Your answers help adults understand how to support you better—at home, at school, or elsewhere. You can choose not to answer any question that makes you feel uncomfortable.

Section 1: Emotional Wellbeing

Section 2: Supplementary Neurodivergent Needs

For Clinician Use Only

ABC Mental Health Support Ltd is registered with the Information Commissioner’s Office (ICO) and fully complies with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018. All personal data is collected, processed, and stored lawfully, securely, and confidentially.