3
I feel sad or empty.......
When I have a problem, I get a funny feeling in my
stomach......
I worry when I think I have done poorly at something.........
I would feel afraid of being on my own at home
Nothing is much fun anymore.....
I feel scared when I have to take a test
I feel worried when I think someone is angry with me.........
I worry about being away from my parents
10
I get bothered by bad or silly thoughts or pictures in my
mind.......
11
I have trouble sleeping......
12
I worry that I will do badly at my school work
13
I worry that something awful will happen to someone in
my family.....
14
I suddenly feel as if I can't breathe when there is no reason for
this......
15
I have problems with my appetite....
16
I have to keep checking that I have done things right (like
the switch is off, or the door is locked)........
17
I feel scared if I have to sleep on my own..
18
I have trouble going to school in the mornings because I
feel nervous or afraid....
19
I have no energy for things.....
20
I worry I might look foolish.....
21
I am tired a lot......
22
I worry that bad things will happen to me
ObsessiveCompulsive
Generalized
Anxiety
Separation
Anxiety
Always
Major
Depression
Often
I worry about things
Panic
Disorder
Sometimes
Social Phobia
Never
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2011 Copyright
24
When I have a problem, my heart beats really fast........
25
I cannot think clearly.......
26
I suddenly start to tremble or shake when there is no reason for
this.......
27
I worry that something bad will happen to me
28
When I have a problem, I feel shaky...
29
I feel worthless........
30
I worry about making mistakes....
31
I have to think of special thoughts (like numbers or words) to
stop bad things from happening
32
I worry what other people think of me...
33
I am afraid of being in crowded places (like shopping centers,
the movies, buses, busy playgrounds).........
34
All of a sudden I feel really scared for no reason at all...........
35
I worry about what is going to happen...
36
I suddenly become dizzy or faint when there is no reason
for this........
37
I think about death.......
38
I feel afraid if I have to talk in front of my class
39
My heart suddenly starts to beat too quickly for no reason..........
40
I feel like I dont want to move....
41
I worry that I will suddenly get a scared feeling when there is
nothing to be afraid of...
42
I have to do some things over and over again (like washing my
hands, cleaning or putting things in a certain order)......
43
I feel afraid that I will make a fool of myself in front of people......
44
I have to do some things in just the right way to stop bad things
from happening....
45
I worry when I go to bed at night....
46
I would feel scared if I had to stay away from home overnight......
47
I feel restless.......
Please, insert the number of the box you have marked in
the box under the letters that is left blank. Then sum up the
numbers for each letters column.
ObsessiveCompulsive
Generalized
Anxiety
Separation
Anxiety
Always
Major
Depression
Often
Panic
Disorder
Sometimes
I can't seem to get bad or silly thoughts out of my
head...........
Social Phobia
Never
23
SUMS
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RCAD Scores C h i l d / Y o u n g P e r s o n
2011 Copyright
