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The Generalised Anxiety Disorder ChecklistStudent Name:
Student Age:
Name of person completing form:
Children with GAD, experience excessive anxiety and worry, occurring more days than not for at least 6 months, concerning a number of events. These symptoms are excessive, intrusive, persistent and debilitating.NB: This checklist is not a diagnostic tool but provides information about a student’s behaviour. Read each phrase below and mark the response that best describes the individual’s behaviour. Please add comments below each item relating to observations of the student.
Difficulties with controlling worries
o Has unreasonable worries about things before they happen
o
o Has many worries about friends, school, or activities that occur more days than not.
o
o Shows an inability to control worry
o
o Ruminating, resulting in making events feel bigger than they may be.
o
o The potential to focus on the negative side of things and imagining the worst
o
TIM DANSIE PSYCHOLOGYTrading as Dansie’s Head to Toe Pty Ltd
T2, 33 Warwick Street, Walkerville SA 5081Telephone (08 82691818 Fax (08) 82691802 Email – [email protected]
ABN: 43 103 052 991
o Excessive worry about a change in routine
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o Repetitive, unwanted thoughts (worries or obsessions) or actions (compulsions or avoidance of certain situations)
o
o Fears of meeting or talking to people.
o
o Rigidity and inflexibility, self-criticism, guilty thoughts, etc.
o
Difficulties with restlessness and being on edge
o The need for clarification and the potential for excessive questioning.
o
o Is frequently on edge
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o Experiences constant thoughts and fears about safety of self or family members
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o Need for affirmation
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o Inability to relax and restlessness
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o Clingy behaviour with family members
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o Restlessness, irritability, tantrums
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o Avoidance behaviours, such as avoiding things or places or refusing to do things or go places
Tim Dansie Psychology – 82691818 2
Fatigue
o Muscle aches or tension
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o Is easily tired
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o Sleep difficulties such as having trouble falling asleep, or restless and unsatisfying sleep
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o Frequent stomach-aches, headaches, or other physical complaints
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o Refusing to go to school
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o Crying
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o Appears sad or depressed
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o Feelings of loneliness
Difficulties with concentration
o Shows a lack of concentration and motivation
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o Disinterested
o Perfectionism and procrastination
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o Poor memory
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o Demonstrates fears of embarrassment or making mistakesTim Dansie Psychology – 82691818 3
o Shows a low self- esteem and lack of self-confidence
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o Fatigue
Irritability
o Being easily startled
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o Irritability and hypervigilance.
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o Unwillingness to engage in unfamiliar situations
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o Feeling as though there is a lump in the throat
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o Opposition and defiance
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