PROMIS Emotional Distress- Anxiety- Pediatric Item Bank

Question Title

* 1. Please fill in the demographic information below

Question Title

* 2. Instructions to the child:  On the DSM-5 Level I cross cutting questionnaire that you just completed/ you indicated that during the past 2 weeks you have been bothered by "feeling nervous, anxious or scared", "not being able to stop worrying" and/ or "not being able to do things you wanted to or should have done because they made you feel nervous" at a mild or greater level of severity.  The questions below ask about these feelings in more detail and especially how often your child receiving care has been bothered by a list of symptoms during the past 7 daysPlease respond to each item by selecting one box per row.

  1- Never 2- Almost Never 3- Sometimes 4- Often 5- Almost Always
1. I felt like something awful might happen.
2. I felt nervous.
3. I felt scared.
4. I felt worried.
5. I worried about what could happen to me
6. I worried when I went to bed at night.
7. I got scared really easy.
8. I was afraid of going to school.
9. I was worried I might die
10. I woke up at night scared
11. I worried when I was at home.
12. Worried when I was away from home.
13. It was hard for me to relax

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