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    PAS Preschool Anxiety Scale Blank Form

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    Khansa Chaudary
    The document describes the Preschool Anxiety Scale (PAS), a questionnaire for caregivers to assess anxiety levels in preschool-aged children. It consists of 35 questions with response options regarding how often certain anxious behaviors and fears apply to the child. The questions cover worries, fears of situations and objects, compulsive behaviors, distress when separated from caregivers, and potential post-traumatic stress symptoms following adverse experiences. Scoring involves adding up responses to obtain an overall anxiety severity score.

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    PAS Preschool Anxiety Scale Blank Form

    Uploaded by

    Khansa Chaudary
    104 views3 pages
    The document describes the Preschool Anxiety Scale (PAS), a questionnaire for caregivers to assess anxiety levels in preschool-aged children. It consists of 35 questions with response options regarding how often certain anxious behaviors and fears apply to the child. The questions cover worries, fears of situations and objects, compulsive behaviors, distress when separated from caregivers, and potential post-traumatic stress symptoms following adverse experiences. Scoring involves adding up responses to obtain an overall anxiety severity score.

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    The document describes the Preschool Anxiety Scale (PAS), a questionnaire for caregivers to assess anxiety levels in preschool-aged children. It consists of 35 questions with response options regarding how often certain anxious behaviors and fears apply to the child. The questions cover worries, fears of situations and objects, compulsive behaviors, distress when separated from caregivers, and potential post-traumatic stress symptoms following adverse experiences. Scoring involves adding up responses to obtain an overall anxiety severity score.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    104 views3 pages

    PAS Preschool Anxiety Scale Blank Form

    Uploaded by

    Khansa Chaudary
    The document describes the Preschool Anxiety Scale (PAS), a questionnaire for caregivers to assess anxiety levels in preschool-aged children. It consists of 35 questions with response options regarding how often certain anxious behaviors and fears apply to the child. The questions cover worries, fears of situations and objects, compulsive behaviors, distress when separated from caregivers, and potential post-traumatic stress symptoms following adverse experiences. Scoring involves adding up responses to obtain an overall anxiety severity score.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    NovoPsych

    Preschool Anxiety Scale (PAS)

    Instructions:
    Below is a list of items that describe children. For each item please select the response that best describes
    your child. Please answer all the items as well as you can, even if some do not seem to apply to your child.

    Sometimes Quite Often Very Often


    Not True at All Seldom True
    True True True

    1 Has difficulty stopping him/herself from worrying 0 1 2 3 4

    Worries that he/she will do something to look stupid in


    2
    front of other people
    0 1 2 3 4

    Keeps checking that he/she has done things right


    3
    (e.g., that he/she closed a door, turned off a tap)
    0 1 2 3 4

    4 Is tense, restless or irritable due to worrying 0 1 2 3 4

    Is scared to ask an adult for help (e.g., a preschool or


    5
    school teacher)
    0 1 2 3 4

    Is reluctant to go to sleep without you or to sleep


    6
    away from home
    0 1 2 3 4

    7 Is scared of heights (high places) 0 1 2 3 4

    8 Has trouble sleeping due to worrying 0 1 2 3 4

    Washes his/her hands over and over many times


    9
    each day
    0 1 2 3 4

    10 Is afraid of crowded or closed-in places 0 1 2 3 4

    11 Is afraid of meeting or talking to unfamiliar people 0 1 2 3 4

    Worries that something bad will happen to his/her


    12
    parents
    0 1 2 3 4

    13 Is scared of thunder storms 0 1 2 3 4

    Spends a large part of each day worrying about


    14
    various things
    0 1 2 3 4

    Is afraid of talking in front of the class (preschool


    15
    group) e.g., show and tell
    0 1 2 3 4
    Worries that something bad might happen to him/her (e.g.,
    16 getting lost or kidnapped), so he/she won’t be able to see 0 1 2 3 4
    you again

    Page 1 of 3
    NovoPsych

    Sometimes Quite Often Very Often


    Not True at All Seldom True
    True True True

    17 Is nervous of going swimming 0 1 2 3 4

    Has to have things in exactly the right order or


    18
    position to stop bad things from happening
    0 1 2 3 4

    Worries that he/she will do something embarrassing


    19
    in front of other people
    0 1 2 3 4

    20 Is afraid of insects and/or spiders 0 1 2 3 4

    Has bad or silly thoughts or images that keep coming


    21
    back over and over
    0 1 2 3 4

    Becomes distressed about your leaving him/her at


    22
    preschool/school or with a babysitter
    0 1 2 3 4

    Is afraid to go up to group of children and join their


    23
    activities
    0 1 2 3 4

    24 Is frightened of dogs 0 1 2 3 4

    25 Has nightmares about being apart from you 0 1 2 3 4

    26 Is afraid of the dark 0 1 2 3 4

    Has to keep thinking special thoughts (e.g., numbers


    27
    or words) to stop bad things from happening
    0 1 2 3 4

    Asks for reassurance when it doesn’t seem


    28
    necessary
    0 1 2 3 4

    Yes No

    Has your child ever experienced anything really bad or


    29 traumatic (e.g., severe accident, death of a family 1 0
    member/friend, assault, robbery, disaster)

    30 If you answered YES to the previous question, please briefly describe the event that your child experienced:

    Sometimes Quite Often Very Often


    Not True at All Seldom True
    True True True
    If you answered NO to question 29, please do not answer questions 31-35. If you answered YES, please DO answer the
    following questions.

    31 Do the following statements describe your child’s behaviour since the event? 0 1 2 3 4
    Has bad dreams or nightmares about the event

    32 Remembers the event and becomes distressed 0 1 2 3 4

    33 Becomes distressed when reminded of the event 0 1 2 3 4

    Page 2 of 3
    NovoPsych

    Sometimes Quite Often Very Often


    Not True at All Seldom True
    True True True

    Suddenly behaves as if he/she is reliving the bad


    34
    experience
    0 1 2 3 4

    Shows bodily signs of fear (e.g., sweating, shaking or


    35
    racing heart) when reminded of the event
    0 1 2 3 4

    Developer Reference:
    Spence, S. H., Rapee, R., McDonald, C., & Ingram, M. (2001). The structure of anxiety symptoms among
    preschoolers. Behaviour Research and Therapy, 39(11), 1293–1316.
    https://doi.org/10.1016/s0005-7967(00)00098-x

    Page 3 of 3

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