Tinnitus and hyperacusis therapy specialist unit

Anxiety (Parent)

Choose the option that shows how often each of these things happens for your child.

For each question please select one number based on how you are feeling now.

1. My child worries about things
2. My child feels sad or empty
3. When my child has a problem, he/she gets a funny feeling in his/her stomach
4. My child worries when he/she thinks he/she has done poorly at something
5. My child feels afraid of being alone at home
6. Nothing is much fun for my child anymore
7. My child feels scared when taking a test
8. My child worries when he/she thinks someone is angry with him/her.
9. My child worries about being away from me
10. My child is bothered by bad or silly thoughts or pictures in his/her mind
11. My child has trouble sleeping
12. My child worries about doing badly at school work
13. My child worries that something awful will happen to someone in the family
14. My child suddenly feels as if he/she can’t breathe when there is no reason for this.
15. My child has problems with his/her appetite
16. My child has to keep checking that he/she has done things right (like the switch is off, or the door is locked)
17. My child feels scared to sleep on his/her own
18. My child has trouble going to school in the mornings because of feeling nervous or afraid.
19. My child has no energy for things
20. My child worries about looking foolish
21. My child is tired a lot
22. My child worries that bad things will happen to him/her
23. My child can’t seem to get bad or silly thoughts out of his/her head.
24. When my child has a problem, his/her heart beats really fast
25. My child cannot think clearly
26. My child suddenly starts to tremble or shake when there is no reason for this
27. My child worries that something bad will happen to him/her
28. When My child has a problem, he/she feels shaky
29. My child feels worthless
30. My child worries about making mistakes
31. My child has to think of special thoughts (like numbers or words) to stop bad things from happening
32. My child worries what other people think of him/her
33. My child is afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds)
34. All of a sudden my child will feel really scared for no reason at all
35. My child worries about what is going to happen
36. My child suddenly becomes dizzy or faint when there is no reason for this
37. My child thinks about death
38. My child feels afraid if he/she have to talk in front of the class
39. My childs heart suddenly starts to beat too quickly for no reason
40. My child feels like he/she doesnt want to move
41. My child worries that he/she will suddenly get a scared feeling when there is nothing to be afraid of
42. My child has to do some things over and over again (like washing hands, cleaning, or putting things in a certain order)
43. My child feels afraid that he/she will make a fool of him/herself in front of people
44. My child has to do some things in just the right way to stop bad things from happening
45. My child worries when in bed at night
46. My child would feel scared if he/she had to stay away from home overnight
47. My child feels restless
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