Screen for Child Anxiety Disorder (SCARED) Parent Version
Patient's Name
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First Name
Last Name
Patient's Date of Birth
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Month
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Day
Year
Date
Today's Date
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Month
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Day
Year
Date
When my child feels frightened, it is hard for him/her to breathe.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child gets headaches when he/she is at school.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child doesn't like to be with people he/she doesn't know well.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child gets scared if he/she sleeps away from home.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child worries about other people liking him/her.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
When my child gets frightened, he/she feels like passing out.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child is nervous.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child follows me wherever I go.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
People tell me that my child looks nervous.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child feels nervous with people he/she doesn't know well.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child gets stomachaches at school.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
When my child gets frightened, he/she feels like he/she is going crazy.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child worries about sleeping alone.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child worries about being as good as other kids.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
When he/she gets frightened, he/she feels like things are not real.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child has nightmares about something bad happening to his/her parents.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child worries about going to school.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
When my child gets frightened, his/her heart beats fast.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
He/she gets shaky.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child has nightmares about something bad happening to him/her.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child worries about things working out for him/her.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
When my child gets frightened, he/she sweats alot.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child is a worrier.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child gets really frightened for no reason at all.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child is afraid to be alone in the house.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
It is hard for my child to talk to people he/she doesn't know well.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
When my child gets frightened, he/she feels like he/she is choking.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
People tell me that my child worries too much.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child doesn't like to be away from his/her family.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child is afraid of having anxiety (or panic) attacks.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child worries about what is going to happen in the future.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
When my child gets frightened, he/she feels like throwing up.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child worries about how well he/she does things.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child is scared to go to school.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child worries about things that have already happened.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
When my child gets frightened, he/she feels dizzy.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
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)
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child feels nervous when he/she is going to parties, dances, or any place where there will be people that he/she doesn't know well.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
My child is shy.
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Not true or hardly ever true (0)
Somewhat true of sometimes true (1)
Very true or often true (2)
Name of Guardian completing assessment
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First Name
Last Name
Relationship to Patient
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