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Ebesutani et al. (2012). Short form for ages 8–18 — screens for anxiety and depression symptoms.

1. 1.I worry about things.

   • [0]0 — Never
   • [1]1 — Sometimes
   • [2]2 — Often
   • [3]3 — Always

2. 2.I feel sad or empty.

   • [0]0 — Never
   • [1]1 — Sometimes
   • [2]2 — Often
   • [3]3 — Always

3. 3.When I have a problem, I get a funny feeling in my stomach.

   • [0]0 — Never
   • [1]1 — Sometimes
   • [2]2 — Often
   • [3]3 — Always

4. 4.I worry when I think I have done poorly at something.

   • [0]0 — Never
   • [1]1 — Sometimes
   • [2]2 — Often
   • [3]3 — Always

5. 5.I would feel afraid of being on my own at home.

   • [0]0 — Never
   • [1]1 — Sometimes
   • [2]2 — Often
   • [3]3 — Always

6. 6.Nothing is much fun anymore.

   • [0]0 — Never
   • [1]1 — Sometimes
   • [2]2 — Often
   • [3]3 — Always

7. 7.I feel scared when I have to take a test.

   • [0]0 — Never
   • [1]1 — Sometimes
   • [2]2 — Often
   • [3]3 — Always

8. 8.I feel worried when I think someone is angry with me.

   • [0]0 — Never
   • [1]1 — Sometimes
   • [2]2 — Often
   • [3]3 — Always

9. 9.I worry about being away from my parents.

   • [0]0 — Never
   • [1]1 — Sometimes
   • [2]2 — Often
   • [3]3 — Always

10. 10.I am bothered by bad or silly thoughts or pictures in my mind.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

11. 11.I have trouble sleeping.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

12. 12.I worry that I will do badly at my school work.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

13. 13.I worry that something awful will happen to someone in my family.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

14. 14.I suddenly feel as if I can't breathe when there is no reason for this.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

15. 15.I have problems with my appetite.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

16. 16.I have to keep checking that I have done things right.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

17. 17.I have no energy for things.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

18. 18.I suddenly start to tremble or shake when there is no reason for this.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

19. 19.I cannot think clearly.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

20. 20.I feel worthless.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

21. 21.I have to think of special thoughts to stop bad things from happening.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

22. 22.I worry that something bad will happen to me.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

23. 23.I think about death.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

24. 24.I feel like I don't want to move.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always

25. 25.I worry when I go to bed at night.

    • [0]0 — Never
    • [1]1 — Sometimes
    • [2]2 — Often
    • [3]3 — Always