Below is a list of problems that kids sometimes have after experiencing an upsetting event. Read each one carefully and check the appropriate box that best describes how often that problem has bothered you IN THE LAST 2 WEEKS.


Rating Scale
0 = Not at all or only at one time
1 = Once per week or less, once in awhile
2 = 2 to 4 times per week/half the time
3 = 5 or more time per week/almost always

0 1 2 3
1. Having upsetting thoughts or images about the event that came into your head when you didn’t want them to
2. Having bad dreams or nightmares
3. Acting or feeling as if the event was happening again (hearing something or seeing a picture about it and feeling as if you are there again)
4. Feeling upset when you think about it or hear about the event (e.g., feeling scared, angry, sad, guilty, etc.)
5. Having feelings in your body when you think about or hear about the event (e.g., breaking out into a sweat, heart beating fast)
6. Trying not to think about, talk about, or have feelings about the event
7. Trying to avoid activities, people, or places that remind you of the traumatic event
8. Not being able to remember an important part of the upsetting event
9. Having much less interest in doing things you used to do
10. Not feeling close to people around you
11. Not being able to have strong feelings (e.g., being unable to cry or unable to feel happy)
12. Feeling as if your future plans or hopes will not come true (e.g., you will not have a job or get married or have kids)
13. Having trouble falling or staying asleep
14. Feeling irritable or having fits of anger
15. Having trouble concentrating (e.g., losing track of a story on the television, forgetting what you read, not paying attention in class)
16. Being overly careful (e.g., checking to see who is around you and what is around you)
17. Being jumpy or easily startled (e.g., when someone walks up behind you)


Indicate below if the problems you rated in Part 1 have gotten in the way with any of the following areas of your life DURING THE PAST 2 WEEKS.

In the past month, how much were you bothered by: No Yes
18. Prayers
19. Chores and duties at home
20. Relationships with friends
21. Fun and hobby activities
22. Schoolwork
23. Relationships
24. General happiness with your life