Please answer every question.
Over the past two weeks or more, how often have you observed or been concerned about any of the following in your child?
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Question
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Almost Never
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Sometimes
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Often
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Very Often
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| 1: Your child appeared anxious, fearful or unusually apprehensive? |
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| 2: Expressed thoughts, feelings or concerns about potential treats or fears? |
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| 3: Displayed signs of being emotionally more vulnerable and demanding more frequent attention or reassurance? |
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| 4: Performed habitual or repetitive behaviours such as fidgeting, nail biting, skin picking, lip or cheek biting, etc? |
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| 5: Had excessive, ongoing, or repetitive concerns about their own health or the health of close family members / friends? |
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| 6: Expressed or displayed significant fear or anxiety about being separated from you, family members or caregivers? |
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| 7: Complained that their minds went blank under pressure, such as during exams, class participation, etc? |
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| 8: Developed non-specific symptoms such as headaches, nausea or stomach ache without really appearing sick? |
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| 9: Had trouble falling or staying asleep? |
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| 10: Wanted to avoid stressful situations or interactions such as school, social gatherings, etc. with increasing frequency? |
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| 11: Had persistent, excessive and unreasonable fears or phobias of certain objects, people, animals, situations or imaginary creatures? |
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| 12: Displayed unusually naughty or disruptive behaviour under certain conditions in a social context? |
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