Amen Child/teen General Symptom Checklist (Page 2 of 4) in pdf

(_____) (_____) 23. periods of trembling, shaking or sweating

(_____) (_____) 24. periods of nausea, abdominal upset or choking

(_____) (_____) 25. intense fear of dying

(_____) (_____) 26. lacks confidence in abilities

(_____) (_____) 27. needs lots of reassurance

(_____) (_____) 28. needs to be perfect

(_____) (_____) 29. seems fearful and anxious

(_____) (_____) 30. seems shy or timid

(_____) (_____) 31. easily embarrassed

(_____) (_____) 32. sensitive to criticism

(_____) (_____) 33. bites fingernails or chews clothing

(_____) (_____) 34. persistent refusal to go to school

(_____) (_____) 35. excessive fear of interacting with other children or adults

(_____) (_____) 36. persistent, excessive fear (heights, closed spaces, specific animals, etc.)

please list: __________________________________________

(_____) (_____) 37. excessive anxiety concerning separation from home or person.

(_____) (_____) 38. recurrent bothersome thoughts, ideas or images which you try to ignore

(_____) (_____) 39. trouble getting "stuck" on certain thoughts, or having the same thought

over and over

(_____) (_____) 40. excessive or senseless worrying

(_____) (_____) 41. others complain that you worry too much or get "stuck" on thoughts

(_____) (_____) 42. compulsive behaviors that you must do or you feel very anxious, such as

excessive hand washing, cleaning, checking locks, or counting or spelling

(_____) (_____) 43. needing to have things done a certain way or you become very upset

(_____) (_____) 44. recurrent and upsetting thoughts of a past traumatic event (molest,

accident, fire, etc) please list: _______________________________

(_____) (_____) 45. recurrent distressing dreams of a past upsetting event

(_____) (_____) 46. feelings of reliving a past upsetting event

(_____) (_____) 47. spend effort avoiding thoughts or feelings related to a past trauma

(_____) (_____) 48. feeling that your future is shortened

(_____) (_____) 49. startle easily

(_____) (_____) 50. feel like you're always watching for bad things to happen

(_____) (_____) 51. refusal to maintain body weight above healthy levels.

Amen Child/teen General Symptom Checklist Page 2