Example 1. Social Motivation
Does your child seem interested in being around others? Does your child watch and appear interested in joining in with others, even if she doesn’t know how? Has your child shown a clear desire to make friends? Has his/her interest changed overtime? What do you think caused this change? Sample Anchors: 0 = Child displays clear desire to engage socially and develop friendship even if s/he has not been successful; 3 = Child seeks social interaction only as a means to an end (e.g., to obtain a need or want).
Example 2. Bullying/ Peer Rejection
Has your child been rejected by peers, picked on or bullied? How often? What happened? Has she also had positive interactions or relationships? Sample Anchors: 0 = No bullying/rejection; 3 = Severe. Significant rejection and/or bullying, resulting in child’s refusal to attend school or other activities or parents removal of child from school/activities due to concern for their welfare.
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| Ambiguous Anxiety-Like Symptoms (0 – 8 Clinician Severity Rating) |
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Example 1. Fear of Change
Does your child worry excessively about changes in his/her routine (e.g., substitute teacher, being dropped off by different person) or personal surroundings? Or about changes in routine or appearance of others? Does your child worry about the time or about changes in rules? Does your child worry ahead of time about potential changes? How does your child react if the change is positive (e.g., getting out of school early)? Sample Anchors: 2 = worry ahead of time about changes in routine/environment, but can typically recover and continue to function. No accommodation needed; 4 = worries excessively about potential changes in routine/environment and/or novelty such that child or family’s functioning is limited. 6 = anticipatory worries about change or novelty cause substantial impairment to child or family functioning (e.g., child may not leave house at times or may refuse activities due to difficulties coping with unexpected events).
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