PEDIATRIC ANXIETY RATING SCALE (PARS) Version 1.

2 July 11, 1997 This instrument was developed by the Research Units o !ediatric !sychopharmacolo"y #RU!!s$ at Johns %op&ins 'edical (nstitutions, 'ar& ). Riddle, '.*., !(, and at the +olle"e o !hysicians and ,ur"eons, +olumbia University, -aurence -. .reenhill, !(. This e ort was unded by the /ational (nstitute o 'ental %ealth, 0enedetto Vitiello, '.*., !ro1ect 2 icer. %elp ul consultation was provided by !rudence 3isher, !h.*., +olumbia University. !lease obtain permission to use, copy or cite this instrument rom *r. Riddle #415.966.2725$ or *r. .reenhill #212.985.2745$. INSTRUCTIONS 2verview9 The !ediatric )n:iety Ratin" ,cale #!)R,$ is to be used to rate the severity o an:iety in children and adolescents, a"es 8 to 17 years. The !)R, has two sections9 the symptom chec&list and the severity items. The symptom chec&list is used to determine the child;s repertoire o symptoms durin" the past wee&. The 7< severity item is used to determine severity o symptoms and the !)R, total score. ,ymptoms include in the ratin" are commonly observed in patients with the ollowin" disorder, panic disorder and speci ic phobia. 2bviously, there is considerable overlap in symptoms amon" these an:iety disorders. ,ymptoms speci ic to obsessive compulsive disorder and post traumatic stress disorder are not included. The time rame or the !)R, ratin" is the past wee&. 2nly those symptoms endorsed or the past wee& are included in the symptom chec&list and rated on the severity items. The respondents should be the same or each ratin" on the same sub1ect. 3or e:ample, in a treatment trial, where the !)R, may be administered multiple times to the same child, it is important that the same primary care"iver #e."., mother$ be present at each ratin". ( both parents are present or the irst ratin", both should be present or subse=uent ratin"s. The ormat o the interview9 The "oal o the interview is to elicit as much in ormation as possible about the child;s level o an:iety. To achieve this "oal, it is necessary to obtain in ormation rom both the child and the primary care"iver #at least$. The clinician combines all in ormation rom all in ormants to ma&e the ratin"s. Usually, or pre<teens, the interviewer starts with the parent#s$ alone and subse=uently interviews the child alone. 3or teena"ers, the reverse order is "enerally pre erred #adolescent irst, ollowed by the parent#s$$. >ith some amilies, it may be pre erable to interview the child and parent#s$ to"ether. 0oth should be told in advance that they will have an opportunity, i indicated, to spea& alone with the interviewer. The order and procedure or interviews should remain constant throu"hout multiple ratin"s. ,ymptom +hec&list9 The symptom chec&list is the irst o the two ma1or sections o the !)R,. The "oal o the chec&list is to document the array o the patient;s symptoms that will be used to establish severity durin" the ratin"s o severity items. Thus, the symptom chec&list is not to be used to establish severity. Use items as probes to elicit the patient;s complete symptom repertoire. ?licit in ormation rom both child and parent#s$. Use your best 1ud"ement to combine in ormation rom all in ormants. Remember, symptoms occurrin" durin" the past wee& only are to be recorded.

,everity Ratin"s9 Usin" all o the symptoms endorsed or the past wee&, rate severity o symptoms or each o the 7 severity items. Use the anchors or each item to assist the child and parent in establishin" severity. Respondents may wonder whether the severity items are ratin" an avera"e or the past wee&, or the worst day, or worst time, etc. The severity items are meant to elicit in ormation about avera"e symptom severity over the past wee&. Record all scores in whole numbers@ in<between scores #e."., 1.6$ are not permitted. 3ollow<up ?valuations9 ?licitin" in ormation about the symptom lisst can be much more e icient durin" subse=uent ratin"s o the same sub1ect. The interviewer can use the symptom chec&list rom the prior ratin" as a "uide. 3or a ollow<up ratin", the interviewer can describe to the sub1ect the symptoms that were endorsed at the prior ratin". Then the interviewer as&s i there have been any new symptoms durin" the past wee&. 3inally, the interviewer uses the probes to be sure that no symptoms have been overloo&ed. %owever, since the sub1ect will be amiliar with the probes rom prior assessments, the probes can be reviewed rapidly, with the e:pectation that they will not be endorsed. ,corin"9 The total score or the !)R, is total o the 7 severity items. The total score ran"es rom 5 to 76. #+odes ABC and A9C are not included in the summation.$ 3or clinical trials, severity is based on the sum o items D2,7,6,8, and 7. ,ample !robes or the ,ymptom -ist9 ,ocial interactions or per ormance situations9 *urin" the past wee&, have you #has sEhe$ worried about or avoided social situaitonsF -et me "ive you some e:amples #re er to list$. *urin" the past wee&, have you #has sEhe$ been shy about or re used to do thin"s in publicF -et me "ive you some more e:amples. Separation Anxiety9 ,ome children worry about bein" away rom their mother or ather. >hat about you #your child$F ,ome children do thin"s to ma&e sure they stay near their mother or atherF >hat about you #your child$F -et me "ive you e:amples. .eneraliGed )n:iety9 ,ome people worry about a lot o di erent thin"s. >hat about you #your child$F >hat about durin" the past wee&F -et me "ive you some e:amples. ,peci ic !hobia9 *o you worry about or have ears o animals #e.". do"$, etcF !hysical ,i"nsE ,ymptoms9 ,ometimes children notice eelin"s or chan"es in their bodies when they are an:ious or worriedF >hat about youF -et me "ive e:amples.

PEDIATRIC ANXIETY RATING SCALE (PARS) SYMPTOM CHECKLIST

(nstructions9 3ill in the blan&s with A1C #yes$, A2C #no$, or A9C #other, e."., unable or unwillin" to answer$ SOCIAL INTERACTIONS or PERFORMANCE SITUATIONS 1. %as ear o andEor avoids participatin" in "roup activities. 2. %as ear o andEor avoids "oin" to a party or social event. 7. %as ear o andEor avoids tal&in" with a stran"er. 4. %as ear o andEor avoids tal&in" on the phone. 6. Reluctant or re uses to tal& in ront o a "roup. 8. Reluctant or re uses to write in ront o other people. 7. Reluctant or re uses to eat in public. B. Reluctant or re uses to use a public bathroom. 9. Reluctant or re uses to chan"e into "ym clothes or bathin" suit with others present. SEPARATION 15. >orry about harm happenin" to attachment i"ures. 11. >orry about harm be allin" sel , includin" the ear o dyin". 12. *istress when separation occurs or is anticipated. 17. 3ear or reluctance to be alone. 14. Reluctance or re usal to "o to school or elsewhere. 16. +omplaints o physical symptoms when separation occurs or is anticipated. 18. Reluctance or re usal to "o to sleep alone. 17. Reluctance or re usal to sleep away rom home. 1B. /i"htmares with a separation theme. 19. +lin"s to parent, or ollows parent around the house. GENERALI"ED 25. ?:cessive worry about everyday or real<li e problems. 21. Restlessness or eelin" &eyed<up or on ed"e. 22. ?asily ati"ued. 27. *i iculty concentratin" or mind "oin" blan&. 24. (rritability. HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH Parent HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH Chi ! HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH Rater HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH

26. 'uscle tension or nonspeci ic tension. 28. ,leep disturbance, especially di iculty allin" asleep. 27. *read or ear ul anticipation #nonspeci ic$. SPECIFIC PHO#IA 2B. )nimal9 ,peci y HHHHHHHHHHHHHHHHHHHHHHHHHHHHH 29. /atural environment9 #e."., hei"hts, storms$ ,peci y9 HHHHHHHHHHHHHHHHHHHHH 75. 0lood<in1ection<in1ury9 ,peci y9 HHHHHHHHHHHHHHHHH 71. ,ituational #e."., airplane, elevator$9 ,peci y9 HHHHHHHHHHHHHHHHHH ACUTE PHYSICAL SIGNS $ SYMPTOMS 72. 0lushin". 77. 3eels paralyGed. 74. Tremblin" or sha&in". 76. 3eels diGGy, unsteady, li"htheaded or "oin" to pass out. 78. !alpitations or poundin" heart. 77. *i icult breathin". #sensation o shortness o breath, smotherin" or cho&in"$. 7B. +hills or hot lashes. 79. ,weatin". 45. 3eels sic& to stomach, nausea or abdominal distress. 41. Recurrent ur"e to "o to bathroom. 42.+hest pain or discom ort. 47. !aresthesias #numbness or tin"lin" sensation in in"ers, toes, or perioral re"ion$. 44. !roblems swallowin" or eatin". OTHER 46. +ryin" spells when in an:iety<provo&in" situations. 48. Temper tantrums when in an:iety<provo&in" situations. 47. /eeds to lee certain an:iety<provo&in" situations. 4B. Ieeps distance rom other people.

HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH HHHHHH

HHHHHH HHHHHH HHHHHH HHHHHH

49. 3ear o losin" control or "oin" craGy. 65. *erealiGation # eelin" o unreality$ or depersonaliGation #detached rom onesel $. 2ther an:iety symptoms9

HHHHHH HHHHHH

HHHHHH HHHHHH

HHHHHH HHHHHH

,peci y9 HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH ,peci y9 HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH ,peci y9 HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH

SE%ERITY ITEMS (nstructions9 3or each item circle the number that best characteriGes the patient durin" the past wee&. &' O(era N)*+er o, An-iet. S.*/to*0 (Cir1 e 1o!e ,or /a0t 2ee3 on .) /ot applicable *oes not &now /o symptoms 1 symptom 2<7 symptoms 4<8 symptoms 7<15 symptoms 'ore than 15 symptoms 4' O(era Fre5)en1. o, An-iet. S.*/to*0 /ot applicable *oes not &now /o symptoms 1 or 2 days a wee& 7 or 4 days a wee& 6 or 8 days a wee& *aily ,everal hours every day 6' O(era Se(erit. o, An-iet. Fee in70 /ot applicable *oes not &now. /one. /o an:ious symptoms. 'inimal9 Very transient discom ort. /ot clinically si"ni icant. Co!e B 9 5 1 2 7 4 6

B 9 5 1 2 7 4 6 B 9 5 1

'ild9 'oderate9

Transient discom ort that is mildly disturbin". 0orderline clinical si"ni icance. (ntermediate between 1and 7. +learly nervous when anticipatin" or con rontin" the an:iety<provo&in" situation#s$. 2 ten unable to overcome these eelin"s. These eelin"s impact on well<bein". Very distressed when an:ious or when anticipatin" or con rontin" the an:iety<provo&in" situation #s$. Usually unable to overcome this eelin". (ntermediate between 7 and 6. 3eels wretched when anticipatin" or con rontin" an:iety<provo&in" situation#s$. 2 ten or almost totally unable to overcome this ear. Very mar&ed impact on well bein".

2 7

,evere9

?:treme9

8' O(era Se(erit. o, Ph.0i1a S.*/to*0 o, An-iet. /ot applicable *oes not &now /one. /o physical symptoms o an:iety. 'inimal9 'ild9 J 'oderate9 Very transient physical symptoms o an:iety. ,ymptoms are not, or are hardly noticeable by others. /ot clinically si"ni icant. 3ew physical symptoms9 no lastin" impact. 0orderline clinical si"ni icance. (ntermediate between 1and 7. !ersistent physical symptoms o an:iety, especially durin" e:posure to the eared situation#s$. ,ymptoms are noticeable by others and si"ni icantly inter ere with hisEher ability to unction in the situation. 'ar&ed physical symptoms o substantial clinical si"ni icance. (ntermediate between 7 and 6. ,evere and persistent physical symptoms o an:iety, especially durin" e:posure to the eared situations#s$. ,ymptoms are very obvious to others and o ten result in inability to unction in the situation.

B 9 5 1 2 7

,evere9 ?:treme9

4 6

9' O(era A(oi!an1e o, An-iet.:Pro(o3in7 Sit)ation0 /2T?9 Rate all avoidance here@ include school, home, activities, etc. in ratin" /ot applicable *oes not &now /one. *oes not avoid the an:iety<provo&in" situation#s$. 'inimal9 'ild9 Very occasionally avoids the an:iety<provo&in" situation#s$. )voided situation#s$ isEare not critical to hisEher well<bein". )voids an:iety<provo&in" situation#s$ some o the time but no important situation is consistently avoided. 0orderline clinical si"ni icance. (ntermediate between 1 and 7. B 9 5 1 2

'oderate9 ,evere9

)void an:iety<provo&in" situation#s$ re=uently. )t least one important situation is avoided. )voids an:iety<provo&in" situation most o the time or more than one important situation is consistently avoided. (ntermediate between 7 and 6. )voids all or almost all an:iety<provo&in" situations.

7 4

?:treme9

6 B 9 5 1 2 7

;' Inter,eren1e 2ith Fa*i . Re ation0hi/0 an!<or Per,or*an1e at Ho*e /ot applicable *oes not &now /one. /o inter erence. 'inimal9 'ild9 'oderate9 Very transient inter erence. /o impact on relationships with amily members or per ormance #tas&s, etc.$ at home. ,li"ht impact on relationships or per ormance outside o the home. 0orderline clinical si"ni icance. (ntermediate between 1 and 7. +lear inter erence. ?ither per ormance o tas&s at home or re=uency or =uality o interaction with amily members is a ected9 heEshe mi"ht withdraw rom interaction, or mi"ht be avoidedEre1ected by amily members, or mi"ht have many con licts with them. 'ar&ed inter erence in relationships with amily members andEor per ormance at home. 2 substantial clinical si"ni icance. (ntermediate between 7 and 6. Totally or almost totally unable to maintain appropriate amily relationship andEor unction at home.

,evere9

?:treme9

=' Inter,eren1e 2ith Peer an! A!) t Re ation0hi/0 $<or Per,or*an1e O)t0i!e o, Ho*e' /2T?9 2ut<o <home unctionin" includes school #not avoidance$, activities, etc /ot applicable *oes not &now /one. /o inter erence. 'inimal9 Very transient inter erence. /o impact on relationships with peers or teachers or other adults outside o the home. /o impact on unctionin" outside o home, e."., attendin" and per ormin" "roup activities. ,li"ht impact on relationships or per ormance outside o the home. 0orderline clinical si"ni icance. (ntermediate between 1 and 7. +lear inter erence. ?ither per ormance outside o the home or re=uency or =uality o peer or adult interactions is a ected9 heEshe mi"ht withdraw rom interaction, or mi"ht be avoidedEre1ected by peers or adults, or mi"ht have con licts with them. B 9 5 1

'ild9 'oderate9

2 7

,evere9

'ar&ed inter erence in relationship with peers or adults outside o home andEor per ormance outside o home. 2 substantial clinical si"ni icance. (ntermediate between 7 and 6. Totally or almost totally unable to maintain appropriate peer or adult relationship andEor unction outside o home.

?:treme9