1. Does your child worry excessively about certain situations, people, or the world at large?
A. They often get apprehensive, and it seems almost impossible to comfort them.
B. They sometimes get worried about something bad happening, yet we can calm them down relatively quickly.
C. They get worried rarely and mostly in an unknown situation; they quickly become calmer when they feel our support.
2. How does your child eat and sleep?
A. They eat regularly and mostly have a good night's sleep.
B. They seem to eat a bit more or less than usual or sometimes have difficulty falling or staying asleep.
C. They eat very much or very little, or have nightmares, wake up often, or can’t fall asleep at night.
3. Is your child restless or fatigued most of the time?
A. They appear more hyperactive or tired at times, which slightly affects their everyday activities.
B. They are restless or exhausted most of the time; they seem too distracted or tired to participate in everyday activities, even play.
C. They are normally calm and have enough energy throughout the day.
4. Does your child have any of the following – muscle tension, headaches, stomachaches, nausea, shaking, and sweating?
A. It happens rarely, and these conditions disappear with the prescribed medication.
B. It happens from time to time, and medication appears to be somewhat effective.
C. It happens often, and medication doesn’t seem to affect them in the long run.
5. Does your child want to avoid everyday social activities, such as playing with friends, going out, meeting new people, or going to school/kindergarten?
A. They get very upset and refuse to participate in such activities.
B. They seem a bit worried whenever the time comes for these activities.
C. They enjoy these activities and go out with great enthusiasm.
6. How does your child react when you go out without them or leave them with other people?
A. They may cry and not let us go outside, yet they get calmer after a while.
B. When they are in a familiar place, they are relatively calm.
C. They get upset and clingy, and it’s tough to comfort them.
7. Is your child irritable or reacts angrily towards you without apparent reason?
A. They may get angry when they’re not allowed something.
B. They appear irritable and unease most of the time and react with opposition to almost everything.
C. They seem more nervous and angry without apparent reason from time to time.
8. How does your child behave when in a new situation or presented with a new task?
A. They are curious about the new environment and openly engage in the activities.
B. They appear a bit cautious, have difficulty loosening up, and engage in the activities with a little push.
C. They seem very cautious and fear making mistakes so that they may participate in the task with our help.
9. Does your child cry or seem overly sensitive in everyday life?
A. They become very upset even in non-provoking situations, and it’s hard to comfort them.
B. They are more sensitive and get upset more easily, yet they calm down after a while.
C. They may cry and become sensitive only when the situation has evoked it.
10. Does your child have specific fears that seem irrational, such as the fear of a certain object, animal, person, or place?
A. They have a fear of the dark or become uneasy whenever there is a storm outside.
B. They get very upset and refuse to look at certain animals or objects or go to specific people or places.
C. They may fear places or people who are not yet familiar with them, yet they are willing to engage with our support.