APA - DSM5 - Level 2 Anxiety Child Age 11 To 17 PDF

The APA is offering a number of “emerging measures” for further research and
clinical evaluation. These patient assessment measures were developed to be

administered at the initial patient interview and to monitor treatment progress.
They should be used in research and evaluation as potentially useful tools to
enhance clinical decision-making and not as the sole basis for making a clinical
diagnosis. Instructions, scoring information, and interpretation guidelines are
provided; further background information can be found in DSM-5. The APA
requests that clinicians and researchers provide further data on the
instruments’ usefulness in characterizing patient status and improving patient
care at https://www.dsm5.org/Pages/Feedback-Form.aspx.
Measure: LEVEL 2—Anxiety—Child Age 11–17 (PROMIS Emotional Distress—

Anxiety—Pediatric Item Bank)
Rights granted: This material can be reproduced without permission by clinicians
for use with their patients. Any other use, including electronic use, requires
written permission of the PROMIS Health Organization (PHO).
Rights holder: PROMIS Health Organization (PHO) and PROMIS Cooperative
Group
To request permission for any other use beyond what is stipulated above,
contact: PROMIS Health Organization (PHO)
LEVEL 2—Anxiety—Child Age 11–17*
*
PROMIS Emotional Distress—Anxiety—Pediatric Item Bank
Name: _______________________ Age: ____ Sex:  Male  Female Date:_____________
Instructions to the child: On the DSM-5 Level 1 cross-cutting questionnaire that you just completed, you indicated that
during the past 2 weeks you have been bothered by “feeling nervous, anxious, or scared”, “not being able to stop
worrying” and/or “not being able to do things you wanted to or should have done because they made you feel nervous”
at a mild or greater level of severity. The questions below ask about these feelings in more detail and especially how
often you have been bothered by a list of symptoms during the past 7 days. Please respond to each item by marking
( or x) one box per row.
Clinician
Use
In the past SEVEN (7) DAYS.… Item Score
Almost Almost
Never Never Sometimes Often Always
1. I felt like something awful might happen.  1 2 3 4 5
2. I felt nervous.  1 2 3 4 5
3. I felt scared.  1 2 3 4 5
4. I felt worried.  1 2 3 4 5
5. I worried about what could happen to me.  1 2 3 4 5
6. I worried when I went to bed at night.  1 2 3 4 5
7. I got scared really easy.  1 2 3 4 5
8. I was afraid of going to school.  1 2 3 4 5
9. I was worried I might die.  1 2 3 4 5
10. I woke up at night scared.  1 2 3 4 5
11. I worried when I was at home.  1 2 3 4 5
12. I worried when I was away from home.  1 2 3 4 5
13. It was hard for me to relax.  1 2 3 4 5
Total/Partial Raw Score:
Prorated Total Raw Score:
T-Score:
*
The PROMIS measure was developed for and can be used with children ages 8-17 but was tested in children ages 11–17 in the DSM-5 Field Trials.
©2008-2012 PROMIS Health Organization (PHO) and PROMIS Cooperative Group.
This material can be reproduced without permission by clinicians for use with their patients.
Any other use, including electronic use, requires written permission of the PHO.
Instructions to Clinicians
The DSM-5 Level 2—Anxiety—Child Age 11–17 measure is the 13-item PROMIS Anxiety Short Form that assesses the
pure domain of anxiety in children and adolescents. The PROMIS Anxiety scale was developed for and can be used with
children ages 8–17; however, it was tested only in children ages 11–17 in the DSM-5 Field Trials. The measure is
completed by the child prior to a visit with the clinician. Each item asks the child receiving care to rate the severity of his
or her anxiety during the past 7 days.
Scoring and Interpretation

Each item on the measure is rated on a 5-point scale (1=never; 2=almost never; 3=sometimes; 4=often; and 5=almost
always) with a range in score from 13 to 65 with higher scores indicating greater severity of anxiety. The clinician is
asked to review the score on each item on the measure during
Score T-Score SE Score T-Score SE the clinical interview and indicate the raw score for each item
13 32.3 5.7 40 64.5 3.1 in the section provided for “Clinician Use.” The raw scores on
14 36.6 4.8 41 65.3 3.1 the 13 items should be summed to obtain a total raw score.
15 38.9 4.6 42 66 3.1 Next, the T-score table should be used to identify the T-score
16 41.1 4.3 43 66.8 3.1 associated with the child’s total raw score and the information
entered in the T-score row on the measure.
17 42.8 4.1 44 67.5 3.1
18 44.3 3.9 45 68.2 3.1 Note: This look-up table works only if all items on the form are
19 45.7 3.8 46 69 3.1 answered. If 75% or more of the questions have been
20 47 3.7 47 69.7 3.1 answered, you are asked to prorate the raw score and then
21 48.2 3.6 48 70.5 3.1 look up the conversion to T-Score. The formula to prorate the
22 49.4 3.5 49 71.3 3.1 partial raw score to Total Raw Score is:
23 50.4 3.4 50 72 3.1
(Raw sum x number of items on the short form)
24 51.4 3.4 51 72.8 3.2 Number of items that were actually answered
25 52.4 3.3 52 73.6 3.2
26 53.3 3.3 53 74.4 3.2 If the result is a fraction, round to the nearest whole number.
27 54.2 3.3 54 75.3 3.2 For example, if 12 of 13 items were answered and the sum of
28 55.1 3.3 55 76.1 3.3 those 12 responses was 40, the prorated raw score would be
29 56 3.2 56 77 3.3 40 X 13/12 = 43, after rounding. The T-score in this example
would be 66.8.
30 56.8 3.2 57 77.9 3.4
31 57.6 3.2 58 78.9 3.4 The T-scores are interpreted as follows:
32 58.4 3.2 59 79.9 3.5
33 59.2 3.2 60 81 3.6 Less than 55 = None to slight
34 60 3.2 61 82.1 3.7 55.0—59.9 = Mild
35 60.8 3.2 62 83.3 3.7 60.0—69.9 = Moderate
70 and over = Severe
36 61.6 3.1 63 84.7 3.8
37 62.3 3.1 64 86.1 3.8 If more than 25% of the total items (in this case more than 3)
38 63.1 3.1 65 88 3.8 are missing a response, the scores should not be used.
39 63.8 3.1 Therefore, the child receiving care should be encouraged to
©2008-2012 PROMIS Health Organization (PHO) complete all of the items on the measure.
and PROMIS Cooperative Group.
Frequency of Use
To track change in the severity of the child’s anxiety over time, the measure may be completed at regular intervals as
clinically indicated, depending on the stability of the child’s symptoms and treatment status. Consistently high scores on
a particular domain may indicate significant and problematic areas for the child that might warrant further assessment,
treatment, and follow-up. Your clinical judgment should guide your decision.
Instructions, scoring, and frequency of use on this page only: Copyright © 2013 American Psychiatric Association. All rights reserved.
This material can be reproduced without permission by researchers and by clinicians for use with their patients.

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The APA is offering a number of “emerging measures” for further research and

clinical evaluation. These patient assessment measures were developed to be

Measure: LEVEL 2—Anxiety—Child Age 11–17 (PROMIS Emotional Distress—

Name: ___________ Age: Sex:  Male  Female Date:_

Scoring and Interpretation

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