Appendix C:

Psychosomatic Questionnaire for Children and Adolescents English Version

Psychosomatic Questionnaire for Children and Adolescents English Version
1. Do you ever feel listless? (not feeling like doing anything at all)	() Often () Sometimes () Never
2. Do you ever feel tired without knowing why exactly?	() Often () Sometimes () Never
3. Do you ever have a headache due to anxiety?	() Often () Sometimes () Never
4. Are there times that you don't feel like eating?	() Often () Sometimes () Never
5. Do you have difficulty falling asleep?	() Often () Sometimes () Never
6. Do you have a sensitive skin, and get rashes, spots or itches?	() Often () Sometimes () Never
7. Do you get stomach pain, near your belly button?	() Often () Sometimes () Never
8. Do you ever notice that you can't relax your muscles very well?	() Often () Sometimes () Never
9. Do you ever feel like crying, with little cause?	() Often () Sometimes () Never