Fill - Free fillable SPENCE CHILDRENS ANXIETY SCALE PDF form

SPENCE CHILDREN’S ANXIETY SCALE

Your Name: DATE:

1. I WORRY ABOUT THINGS......................................................…………........…................

2. AM SCARED OF THE DARK......................................................…………........…..............

3. WHEN I HAVE A PROBLEM, I GET A FUNNY FEELING IN MY STOMACH…............…............

4. I FEEL AFRAID...................................................................………..………....................

5. I WOULD FEEL AFRAID OF BEING ON MY OWN AT HOME......…………………...................

6. I FEEL SCARED WHEN I HAVE TO TAKE A TEST.......................………………....................

7. I FEEL AFRAID IF I HAVE TO USE PUBLIC TOILETS OR BATHROOMS...........……..................

8. I WORRY ABOUT BEING AWAY FROM MY PARENTS......................………………..............

9. I FEEL AFRAID THAT I WILL MAKE A FOOL OF MYSELF IN FRONT OF PEOPLE.......................

10. I WORRY THAT I WILL DO BADLY AT MY SCHOOL WORK...............…………..…..............

11. I AM POPULAR AMONGST OTHER KIDS MY OWN AGE.................……………..….............

12. I WORRY THAT SOMETHING AWFUL WILL HAPPEN TO SOMEONE IN MY FAMILY.................

13. I SUDDENLY FEEL AS IF I CAN’T BREATHE WHEN THERE IS NO REASON FOR THIS...............

14. I HAVE TO KEEP CHECKING THAT I HAVE DONE THINGS RIGHT (LIKE THE SWITCH

IS OFF, OR THE DOOR IS LOCKED).....……………………………………......................

15. I FEEL SCARED IF I HAVE TO SLEEP ON MY OWN....................……………….…...............

16. I HAVE TROUBLE GOING TO SCHOOL IN THE MORNINGS BECAUSE I FEEL NERVOUS

OR AFRAID...................................................…………………………........................

17. I AM GOOD AT SPORTS....................................………………........................................

18. I AM SCARED OF DOGS.....................................................……………….......................

19. I CAN’T SEEM TO GET BAD OR SILLY THOUGHTS OUT OF MY HEAD...………….................

20. WHEN I HAVE A PROBLEM, MY HEART BEATS REALLY FAST....………………..................

21. I SUDDENLY START TO TREMBLE OR SHAKE WHEN THERE IS NO REASON FOR THIS............

22. I WORRY THAT SOMETHING BAD WILL HAPPEN TO ME...…........………………................

Print Form

------------

Last Page

Page 1 of 4

File Number:

(Replace this text with Clinician's Name)

Administered By:

SCAS Boys 12-15

SPENCE CHILDREN’S ANXIETY SCALE

DATE:

23. I AM SCARED OF GOING TO THE DOCTORS OR DENTISTS.........…………………...............

24. WHEN I HAVE A PROBLEM, I FEEL SHAKY...............................……………….................

25. I AM SCARED OF BEING IN HIGH PLACES OR LIFTS (ELEVATOR)…………………..............

26. I AM A GOOD PERSON......................................................…………...…….....................

27. I HAVE TO THINK OF SPECIAL THOUGHTS TO STOP BAD THINGS FROM HAPPENING

(LIKE NUMBERS OR WORDS).......................………………………….…...................

28. I FEEL SCARED IF I HAVE TO TRAVEL IN THE CAR, OR ON A BUS OR A TRAIN.....................

29. I WORRY WHAT OTHER PEOPLE THINK OF ME......................…………………..................

30. I AM AFRAID OF BEING IN CROWDED PLACES (LIKE SHOPPING CENTRES, THE

MOVIES, BUSES, BUSY PLAYGROUNDS).........…………………………………..........

31. I FEEL HAPPY...............................................................................………......................

32. ALL OF A SUDDEN I FEEL REALLY SCARED FOR NO REASON AT ALL……………..............

33. I AM SCARED OF INSECTS OR SPIDERS.....................................……………….................

34. I SUDDENLY BECOME DIZZY OR FAINT WHEN THERE IS NO REASON FOR THIS....................

35. I FEEL AFRAID IF I HAVE TO TALK IN FRONT OF MY CLASS.....…………………................

36. MY HEART SUDDENLY STARTS TO BEAT TOO QUICKLY FOR NO REASON…………............

37. I WORRY THAT I WILL SUDDENLY GET A SCARED FEELING WHEN THERE IS NOTHING

TO BE AFRAID OF....................................…………………………….......................

38. I LIKE MYSELF................................................................……………...........................

39. I AM AFRAID OF BEING IN SMALL CLOSED PLACES, LIKE TUNNELS OR SMALL ROOMS.......

40. I HAVE TO DO SOME THINGS OVER AND OVER AGAIN (LIKE WASHING MY HANDS,

CLEANING OR PUTTING THINGS IN A CERTAIN ORDER)...………………………..........

41. I GET BOTHERED BY BAD OR SILLY THOUGHTS OR PICTURES IN MY MIND…………..........

------------

Page 2 of 4

Last Page

File Number:

SPENCE CHILDREN’S ANXIETY SCALE

DATE:

42. I HAVE TO DO SOME THINGS IN JUST THE RIGHT WAY TO STOP BAD THINGS

HAPPENING................................................…………………….……......................

43. I AM PROUD OF MY SCHOOL WORK.......................................…….……….....................

44. I WOULD FEEL SCARED IF I HAD TO STAY AWAY FROM HOME OVERNIGHT………............

45. Is there something else that you are really afraid of? .....…………...............................

46. PLEASE WRITE DOWN WHAT IT IS:

HOW OFTEN ARE YOU AFRAID OF THIS THING?

------------

Select

Page 3 of 4

Last Page

First Page

File Number:

______________________________________

(Replace this text with Clinician's Name)

Administered By: ______________________________________

Client Signature:

______________________________________

Edit the field above; type the parent/adult guardian's name

Adult Guardian:

Parent:

STOP. You have completed the SCAS.

SPENCE CHILDREN’S ANXIETY SCALE

CLIENT’S NAME: DATE:

SCORE RESULTS

PANIC ATTACK AND AGORAPHOBIA: …...................

SEPARATION ANXIETY: ………………....................

PHYSICAL INJURY FEARS: ……………....................

SOCIAL PHOBIA: ………………………...................

OBSESSIVE COMPULSIVE: ……………....................

GENERALIZED ANXIETY DISORDER: ……................

TOTAL SCAS SCORE: …………………...................

Page 4 of 4

First Page

File Number:

(Replace this text with Clinician's Name)

Administered By: ______________________________________

Reset Form

Score

Range

Select

T-Score

Select

T-Score

Select

T-Score

Select

T-Score

Select

T-Score

Select

T-Score

Total T-Score Range:

Sub Scale T-Score

SCAS Boys 12-15

_________________________________________________________________

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

SPENCE CHILDRENS ANXIETY SCALE

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank SPENCE CHILDRENS ANXIETY SCALE Form

Related forms

Fillable SPENCE CHILDRENS ANXIETY SCALE

Fill Online, Printable, Fillable, Blank SPENCE CHILDRENS ANXIETY SCALE Form

Related forms

First 20 documents completely FREE!