Informal Child & Adolescent Anxiety Checklist (print to use)

The following checklist does not have a scoring key. These are, however, all important dimensions of anxiety that should be discussed with a counselor or psychologist. 

Put an “X” in the appropriate box:



Just a Little

Pretty much

Very Much






The child says he or she is anxious or worried





The child is unusually shy or withdrawn in social situations





The child is afraid of the dark





The child has a poor sleeping pattern





The child is teased by peers or feels he or she has no friends





The child is older than 5 and wants to sleep with parents at night





The child doesn’t want to go to school





The child is fearful that someone will break into the house





The child worries several times a week that one or both of their parents will get hurt or killed in an accident






Everyone experiences anxiety at times.   What is important is the frequency and intensity of these feelings – and whether or not the anxiety is “reality-based” (in which case it will go away when the threat or danger goes away – this is normal anxiety) or “free-floating” (it is not tied to any particular stressor so it does not go away – this is not normal).   Any marks in the “Pretty Much” or “Very Much” columns are “red flags” that should be taken seriously.   High, chronic levels of anxiety are quite disabling and reduce the quality of life.