Screen For Child Anxiety Related Disorders (Scared) Template
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1
2Screen for Child Anxiety Related Disorders (SCARED)
Child Version
- Page 1 of 2 (To be filled out by the CHILD)
Name: ______________________ Date: __________________________
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 you. Then for each sentence, fill in one circle that corresponds to the response that
seems to describe you for the last 3 months.
0
1
2
Not True
Somewhat
Very True
or Hardly
True or
or Often
Ever True
Sometimes
True
True
o
o
o
1.
When I feel frightened, it is hard for me to breathe
2.
I get headaches when I am at school
o
o
o
o
o
o
3.
I don’t like to be with people I don’t know well
o
o
o
4.
I get scared if I sleep away from home
o
o
o
5.
I worry about other people liking me
o
o
o
6.
When I get frightened, I feel like passing out
o
o
o
7.
I am nervous
o
o
o
8.
I follow my mother or father wherever they go
o
o
o
9.
People tell me that I look nervous
o
o
o
10. I feel nervous with people I don’t know well
o
o
o
11. I get stomachaches at school
o
o
o
12. When I get frightened, I feel like I am going crazy
o
o
o
13. I worry about sleeping alone
o
o
o
14. I worry about being as good as other kids
o
o
o
15. When I get frightened, I feel like things are not real
I have nightmares about something bad happening to my par-
o
o
o
16.
ents
o
o
o
17. I worry about going to school
o
o
o
18. When I get frightened, my heart beats fast
o
o
o
19. I get shaky
o
o
o
20. I have nightmares about something bad happening to me
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