Adolescent Generalized Anxiety Disorder Measure -

Generalized Anxiety Disorder

Patient Name*

First Last

Age

Please enter a number from 1 to 18.

Sex

Today's Date*

During the PAST 7 DAYS, I have…

felt moments of sudden terror, fear, or fright*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

felt anxious, worried, or nervous*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

had thoughts of bad things happening, such as family tragedy, ill health, loss of a job, or accidents*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

felt a racing heart, sweaty, trouble breathing, faint, or shaky*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

felt tense muscles, felt on edge or restless, or had trouble relaxing or trouble sleeping*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

avoided, or did not approach or enter, situations about which I worry*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

left situations early or participated only minimally due to worries*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

spent lots of time making decisions, putting off making decisions, or preparing for situations, due to worries*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

sought reassurance from others due to worries*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

needed help to cope with anxiety (e.g., alcohol or medication, superstitious objects, or other people)*

0 – Never
1 – Occasionally
2 – Half of the time
3 – Most of the time
4 – All of the time

Hidden

Total / Partial Raw Score*

Clinician Notes

INSTRUCTIONS:

The following questions ask about thoughts, feelings, and behaviors, often tied to concerns about family, health, finances, school, and work. Please respond to each item by marking one box per row.

Adolescent Generalized Axiety Disorder

Generalized Anxiety Disorder

During the PAST 7 DAYS, I have…