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Please answer the following questions:	Not True or Hardly Ever True (0)	Somewhat True or Sometimes True (1)	Very True or Often True (2)
When my child feels frightened, it is hard for him/her to breathe.	When my child feels frightened, it is hard for him/her to breathe.Not True or Hardly Ever True (0)	When my child feels frightened, it is hard for him/her to breathe.Somewhat True or Sometimes True (1)	When my child feels frightened, it is hard for him/her to breathe.Very True or Often True (2)
My child gets headaches when he/she is at school.	My child gets headaches when he/she is at school.Not True or Hardly Ever True (0)	My child gets headaches when he/she is at school.Somewhat True or Sometimes True (1)	My child gets headaches when he/she is at school.Very True or Often True (2)
My child doesn’t like to be with people he/she doesn't know well.	My child doesn’t like to be with people he/she doesn't know well.Not True or Hardly Ever True (0)	My child doesn’t like to be with people he/she doesn't know well.Somewhat True or Sometimes True (1)	My child doesn’t like to be with people he/she doesn't know well.Very True or Often True (2)
My child gets scared if he/she sleeps away from home.	My child gets scared if he/she sleeps away from home.Not True or Hardly Ever True (0)	My child gets scared if he/she sleeps away from home.Somewhat True or Sometimes True (1)	My child gets scared if he/she sleeps away from home.Very True or Often True (2)
My child worries about other people liking him/her.	My child worries about other people liking him/her.Not True or Hardly Ever True (0)	My child worries about other people liking him/her.Somewhat True or Sometimes True (1)	My child worries about other people liking him/her.Very True or Often True (2)
When my child gets frightened, he/she feels like passing out.	When my child gets frightened, he/she feels like passing out.Not True or Hardly Ever True (0)	When my child gets frightened, he/she feels like passing out.Somewhat True or Sometimes True (1)	When my child gets frightened, he/she feels like passing out.Very True or Often True (2)
My child is nervous.	My child is nervous.Not True or Hardly Ever True (0)	My child is nervous.Somewhat True or Sometimes True (1)	My child is nervous.Very True or Often True (2)
My child follows me wherever I go.	My child follows me wherever I go.Not True or Hardly Ever True (0)	My child follows me wherever I go.Somewhat True or Sometimes True (1)	My child follows me wherever I go.Very True or Often True (2)
People tell me that my child looks nervous.	People tell me that my child looks nervous.Not True or Hardly Ever True (0)	People tell me that my child looks nervous.Somewhat True or Sometimes True (1)	People tell me that my child looks nervous.Very True or Often True (2)
My child feels nervous with people he/she doesn’t know well.	My child feels nervous with people he/she doesn’t know well.Not True or Hardly Ever True (0)	My child feels nervous with people he/she doesn’t know well.Somewhat True or Sometimes True (1)	My child feels nervous with people he/she doesn’t know well.Very True or Often True (2)
My child gets stomachaches at school.	My child gets stomachaches at school.Not True or Hardly Ever True (0)	My child gets stomachaches at school.Somewhat True or Sometimes True (1)	My child gets stomachaches at school.Very True or Often True (2)
When my child gets frightened, he/she feels like he/she is going crazy.	When my child gets frightened, he/she feels like he/she is going crazy.Not True or Hardly Ever True (0)	When my child gets frightened, he/she feels like he/she is going crazy.Somewhat True or Sometimes True (1)	When my child gets frightened, he/she feels like he/she is going crazy.Very True or Often True (2)
My child worries about sleeping alone.	My child worries about sleeping alone.Not True or Hardly Ever True (0)	My child worries about sleeping alone.Somewhat True or Sometimes True (1)	My child worries about sleeping alone.Very True or Often True (2)
My child worries about being as good as other kids.	My child worries about being as good as other kids.Not True or Hardly Ever True (0)	My child worries about being as good as other kids.Somewhat True or Sometimes True (1)	My child worries about being as good as other kids.Very True or Often True (2)
When my child gets frightened, he/she feels like things are not real.	When my child gets frightened, he/she feels like things are not real.Not True or Hardly Ever True (0)	When my child gets frightened, he/she feels like things are not real.Somewhat True or Sometimes True (1)	When my child gets frightened, he/she feels like things are not real.Very True or Often True (2)
My child has nightmares about something bad happening to his/her parents.	My child has nightmares about something bad happening to his/her parents.Not True or Hardly Ever True (0)	My child has nightmares about something bad happening to his/her parents.Somewhat True or Sometimes True (1)	My child has nightmares about something bad happening to his/her parents.Very True or Often True (2)
My child worries about going to school.	My child worries about going to school.Not True or Hardly Ever True (0)	My child worries about going to school.Somewhat True or Sometimes True (1)	My child worries about going to school.Very True or Often True (2)
When my child gets frightened, his/her heart beats fast.	When my child gets frightened, his/her heart beats fast.Not True or Hardly Ever True (0)	When my child gets frightened, his/her heart beats fast.Somewhat True or Sometimes True (1)	When my child gets frightened, his/her heart beats fast.Very True or Often True (2)
He/she gets shaky.	He/she gets shaky.Not True or Hardly Ever True (0)	He/she gets shaky.Somewhat True or Sometimes True (1)	He/she gets shaky.Very True or Often True (2)
My child has nightmares about something bad happening to him/her.	My child has nightmares about something bad happening to him/her.Not True or Hardly Ever True (0)	My child has nightmares about something bad happening to him/her.Somewhat True or Sometimes True (1)	My child has nightmares about something bad happening to him/her.Very True or Often True (2)