Residual Functional Capacity Childhood Mental Disorders Page 5
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83. Persistent unrealistic or excessive anxiety and worry (apprehensive
expectation), accompanied by motor tension, autonomic hyperactivity, or
vigilance and scanning; or
4. A persistent irrational fear of a specific object, activity, or situation which
results in a compelling desire to avoid the dreaded object, activity, or situation; or
5. Recurrent severe panic attacks, manifested by a sudden unpredictable onset of
intense apprehension, fear, or terror, often with a sense of impending doom,
occurring on the average of at least once a week; or
6. Recurrent obsessions or compulsions which are a source of marked distress; or
7. Recurrent and intrusive recollections of a traumatic experience, including
dreams, which are a source of marked distress;
Please be specific identifying whether there exists a markedly restricted repertoire of activities
and interests and explain those limitations based upon the Anxiety Disorder diagnosis and
manifested in one or more of the following behaviors:
1. Excessive anxiety manifested when the child is separated, or separation is
threatened, from a parent or parent surrogate; or
2. Excessive and persistent avoidance of strangers; or
3. Persistent unrealistic or excessive anxiety and worry (apprehensive
expectation), accompanied by motor tension, autonomic hyperactivity, or
vigilance and scanning; or
4. A persistent irrational fear of a specific object, activity, or situation which
results in a compelling desire to avoid the dreaded object, activity, or situation; or
5. Recurrent severe panic attacks, manifested by a sudden unpredictable onset of
intense apprehension, fear, or terror, often with a sense of impending doom,
occurring on the average of at least once a week; or
6. Recurrent obsessions or compulsions which are a source of marked distress; or
7. Recurrent and intrusive recollections of a traumatic experience, including
dreams, which are a source of marked distress;
Have the child’s impairments lasted or can they be expected to last at least twelve months?
Yes
No
Functional Capacity Assessment for Autism
Mental Functional Assessment – Page Number 5
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