DIRECTIONS: Below is a list of sentences that describe how people feel. Read each phrase and decide if it is True or Hardly Ever True” or True or Sometimes True” or True “Not “Somewhat “Very or Often True” for your child. Then for each sentence, circle the number that describes your child best during the past 3 months. Not True Somewhat Very or Hardly True or True or Ever Sometimes Often True True True 1. When my child feels frightened, it is hard for him/her to 0 1 2 breathe. 2. My child gets headaches when he/she is at school. 0 1 2 3. My child doesn’t like to be with people he/she doesn’t 0 1 2 know well. 4. My child gets scared if he/she sleeps away from home. 0 1 2 5. My child worries about other people liking him/her. 0 1 2 6. When my child gets frightened, my child feels like passing 0 1 2 out. 7. My is nervous. 0 1 2 8. My child follow me wherever I go. 0 1 2 9. People tell me that my child looks nervous. 0 1 2 10. My child feels nervous with people he/she doesn’t know 0 1 2 well. 11. My child gets stomachaches at school. 0 1 2 12. When my child gets frightened, he/she feels like he/she 0 1 2 is going crazy. 13. My child worries about sleeping alone. 0 1 2 14. My child worries about being as good as other kids. 0 1 2 15. When my child gets frightened, my child feel like things 0 1 2 are not real. 16. My child has nightmares about something bad 0 1 2 happening to his/her parents. 17. My child worries about going to school. 0 1 2 18. When my child gets frightened, his/her heart beats fast. 0 1 2 19. My child gets shaky. 0 1 2 20. My child has nightmares about something bad 0 1 2 happening to him/her. 21. My child worries about things working out for him/her. 0 1 2
DIRECTIONS: Below is a list of sentences that describe how people feel. Read each phrase 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 sentence, circle the number that describes your child best during the past 3 months. Not True or Hardly Ever True Somewhat True or Sometimes True Very True or Often True 1. When my child feels frightened, it is hard for him/her to breathe. 0 1 2 2. My child gets headaches when he/she is at school. 0 1 2 3. My child doesn’t like to be with people he/she doesn’t know well. 0 1 2 4. My child gets scared if he/she sleeps away from home. 0 1 2 5. My child worries about other people liking him/her. 0 1 2 6. When my child gets frightened, my child feels like passing out. 0 1 2 7. My is nervous. 0 1 2 8. My child follow me wherever I go. 0 1 2 9. People tell me that my child looks nervous. 0 1 2 10. My child feels nervous with people he/she doesn’t know well. 0 1 2 11. My child gets stomachaches at school. 0 1 2 12. When my child gets frightened, he/she feels like he/she is going crazy. 0 1 2 13. My child worries about sleeping alone. 0 1 2 14. My child worries about being as good as other kids. 0 1 2 15. When my child gets frightened, my child feel like things are not real. 0 1 2 16. My child has nightmares about something bad happening to his/her parents. 0 1 2 17. My child worries about going to school. 0 1 2 18. When my child gets frightened, his/her heart beats fast. 0 1 2 19. My child gets shaky. 0 1 2 20. My child has nightmares about something bad happening to him/her. 0 1 2 21. My child worries about things working out for him/her. 0 1 2
SCARED_Parent_Items_Eng.docx