PEDIATRIC ANXIETY RATING SCALE (PARS)

Version 1.2 July 11, 1997

This instrument was developed by the Research Units of Pediatric Psychopharmacology (RUPPs) at
Johns Hopkins Medical Institutions, Mark A. Riddle, M.D., PI, and at the College of Physicians and Surgeons,
Columbia University, Laurence L. Greenhill, PI. This effort was funded by the National Institute of Mental
Health, Benedetto Vitiello, M.D., Project Officer. Helpful consultation was provided by Prudence Fisher, Ph.D.,
Columbia University.
Please obtain permission to use, copy or cite this instrument from Dr. Riddle (410.955.2320) or Dr.
Greenhill (212.960.2340).

INSTRUCTIONS

Overview: The Pediatric Anxiety Rating Scale (PARS) is to be used to rate the severity of anxiety in children
and adolescents, ages 6 to 17 years. The PARS has two sections: the symptom checklist and the severity items.
The symptom checklist is used to determine the child’s repertoire of symptoms during the past week. The 7-
severity item is used to determine severity of symptoms and the PARS total score.
Symptoms include in the rating are commonly observed in patients with the following disorder, panic
disorder and specific phobia. Obviously, there is considerable overlap in symptoms among these anxiety
disorders. Symptoms specific to obsessive compulsive disorder and post traumatic stress disorder are not
included.
The time frame for the PARS rating is the past week. Only those symptoms endorsed for the past week
are included in the symptom checklist and rated on the severity items.
The respondents should be the same for each rating on the same subject. For example, in a treatment
trial, where the PARS may be administered multiple times to the same child, it is important that the same
primary caregiver (e.g., mother) be present at each rating. If both parents are present for the first rating, both
should be present for subsequent ratings.

The format of the interview: The goal of the interview is to elicit as much information as possible about the
child’s level of anxiety. To achieve this goal, it is necessary to obtain information from both the child and the
primary caregiver (at least). The clinician combines all information from all informants to make the ratings.
Usually, for pre-teens, the interviewer starts with the parent(s) alone and subsequently interviews the
child alone. For teenagers, the reverse order is generally preferred (adolescent first, followed by the parent(s)).
With some families, it may be preferable to interview the child and parent(s) together. Both should be told in
advance that they will have an opportunity, if indicated, to speak alone with the interviewer. The order and
procedure for interviews should remain constant throughout multiple ratings.

Symptom Checklist: The symptom checklist is the first of the two major sections of the PARS. The goal of the
checklist is to document the array of the patient’s symptoms that will be used to establish severity during the
ratings of severity items. Thus, the symptom checklist is not to be used to establish severity.
Use items as probes to elicit the patient’s complete symptom repertoire. Elicit information from both
child and parent(s). Use your best judgement to combine information from all informants. Remember,
symptoms occurring during the past week only are to be recorded.
Severity Ratings: Using all of the symptoms endorsed for the past week, rate severity of symptoms for each of
the 7 severity items. Use the anchors for each item to assist the child and parent in establishing severity.
Respondents may wonder whether the severity items are rating an average for the past week, or the worst day,
or worst time, etc. The severity items are meant to elicit information about average symptom severity over the
past week. Record all scores in whole numbers; in-between scores (e.g., 1.5) are not permitted.

Follow-up Evaluations: Eliciting information about the symptom lisst can be much more efficient during
subsequent ratings of the same subject. The interviewer can use the symptom checklist from the prior rating as
a guide. For a follow-up rating, the interviewer can describe to the subject the symptoms that were endorsed at
the prior rating. Then the interviewer asks if there have been any new symptoms during the past week. Finally,
the interviewer uses the probes to be sure that no symptoms have been overlooked. However, since the subject
will be familiar with the probes from prior assessments, the probes can be reviewed rapidly, with the
expectation that they will not be endorsed.

Scoring: The total score for the PARS is total of the 7 severity items. The total score ranges from 0 to 35.
(Codes “8” and “9” are not included in the summation.) For clinical trials, severity is based on the sum of items
#2,3,5,6, and 7.

Sample Probes for the Symptom List: Social interactions or performance situations: During the past week,
have you (has s/he) worried about or avoided social situaitons? Let me give you some examples (refer to list).
During the past week, have you (has s/he) been shy about or refused to do things in public? Let me give you
some more examples.
Separation Anxiety: Some children worry about being away from their mother or father. What about
you (your child)? Some children do things to make sure they stay near their mother or father? What about you
(your child)? Let me give you examples.
Generalized Anxiety: Some people worry about a lot of different things. What about you (your child)?
What about during the past week? Let me give you some examples.
Specific Phobia: Do you worry about or have fears of animals (e.g. dog), etc?
Physical Signs/ Symptoms: Sometimes children notice feelings or changes in their bodies when they are
anxious or worried? What about you? Let me give examples.
 PEDIATRIC ANXIETY RATING SCALE (PARS)

SYMPTOM CHECKLIST
Instructions: Fill in the blanks with “1” (yes), “2” (no), or “9” (other, e.g., unable or unwilling to answer)

SOCIAL INTERACTIONS or PERFORMANCE SITUATIONS Parent Child Rater

1. Has fear of and/or avoids participating in group activities. ______ ______ ______
2. Has fear of and/or avoids going to a party or social event. ______ ______ ______
3. Has fear of and/or avoids talking with a stranger. ______ ______ ______
4. Has fear of and/or avoids talking on the phone. ______ ______ ______
5. Reluctant or refuses to talk in front of a group. ______ ______ ______
6. Reluctant or refuses to write in front of other people. ______ ______ ______
7. Reluctant or refuses to eat in public. ______ ______ ______
8. Reluctant or refuses to use a public bathroom. ______ ______ ______
9. Reluctant or refuses to change into gym clothes or bathing suit
with others present. ______ ______ ______

SEPARATION
10. Worry about harm happening to attachment figures. ______ ______ ______
11. Worry about harm befalling self, including the fear of dying. ______ ______ ______
12. Distress when separation occurs or is anticipated. ______ ______ ______
13. Fear or reluctance to be alone. ______ ______ ______
14. Reluctance or refusal to go to school or elsewhere. ______ ______ ______
15. Complaints of physical symptoms when separation occurs
or is anticipated. ______ ______ ______
16. Reluctance or refusal to go to sleep alone. ______ ______ ______
17. Reluctance or refusal to sleep away from home. ______ ______ ______
18. Nightmares with a separation theme. ______ ______ ______
19. Clings to parent, or follows parent around the house. ______ ______ ______

GENERALIZED
20. Excessive worry about everyday or real-life problems. ______ ______ ______
21. Restlessness or feeling keyed-up or on edge. ______ ______ ______
22. Easily fatigued. ______ ______ ______
23. Difficulty concentrating or mind going blank. ______ ______ ______
24. Irritability. ______ ______ ______
25. Muscle tension or nonspecific tension. ______ ______ ______
26. Sleep disturbance, especially difficulty falling asleep. ______ ______ ______
27. Dread or fearful anticipation (nonspecific). ______ ______ ______

SPECIFIC PHOBIA
28. Animal: Specify _____________________________ ______ ______ ______
29. Natural environment:
(e.g., heights, storms) Specify: _____________________ ______ ______ ______
30. Blood-injection-injury: Specify: _________________ ______ ______ ______
31. Situational
(e.g., airplane, elevator): Specify: __________________ ______ ______ ______

ACUTE PHYSICAL SIGNS & SYMPTOMS

32. Blushing. ______ ______ ______
33. Feels paralyzed. ______ ______ ______
34. Trembling or shaking. ______ ______ ______
35. Feels dizzy, unsteady, lightheaded or going to pass out. ______ ______ ______
36. Palpitations or pounding heart. ______ ______ ______
37. Difficult breathing. ______ ______ ______
(sensation of shortness of breath, smothering or choking). ______ ______ ______
38. Chills or hot flashes. ______ ______ ______
39. Sweating. ______ ______ ______
40. Feels sick to stomach, nausea or abdominal distress. ______ ______ ______
41. Recurrent urge to go to bathroom. ______ ______ ______
42.Chest pain or discomfort. ______ ______ ______
43. Paresthesias
(numbness or tingling sensation in fingers, toes, or perioral region). ______ ______ ______
44. Problems swallowing or eating. ______ ______ ______

OTHER
45. Crying spells when in anxiety-provoking situations. ______ ______ ______
46. Temper tantrums when in anxiety-provoking situations. ______ ______ ______
47. Needs to flee certain anxiety-provoking situations. ______ ______ ______
48. Keeps distance from other people. ______ ______ ______
49. Fear of losing control or going crazy. ______ ______ ______
50. Derealization (feeling of unreality)
or depersonalization (detached from oneself). ______ ______ ______
Other anxiety symptoms: Specify: ___________________________________
Specify: ___________________________________
Specify: ___________________________________

SEVERITY ITEMS
Instructions: For each item circle the number that best characterizes the patient during the past week.

1. Overall Number of Anxiety Symptoms (Circle code for past week only) Code
Not applicable 8
Does not know 9
No symptoms 0

1 symptom 1

2-3 symptoms 2

4-6 symptoms 3

7-10 symptoms 4

More than 10 symptoms 5

2. Overall Frequency of Anxiety Symptoms

Not applicable 8
Does not know 9
No symptoms 0

1 or 2 days a week 1

3 or 4 days a week 2

5 or 6 days a week 3

Daily 4

Several hours every day 5

3. Overall Severity of Anxiety Feelings

Not applicable 8
Does not know. 9
None. No anxious symptoms. 0

Minimal: Very transient discomfort. Not clinically significant. 1

Mild: Transient discomfort that is mildly disturbing. Borderline clinical
significance. Intermediate between 1and 3. 2

Moderate: Clearly nervous when anticipating or confronting the anxiety-provoking 3

situation(s). Often unable to overcome these feelings.
These feelings impact on well-being.

Severe: Very distressed when anxious or when anticipating or confronting 4

the anxiety-provoking situation (s). Usually unable to overcome this feeling.
Intermediate between 3 and 5.

Extreme: Feels wretched when anticipating or confronting 5

anxiety-provoking situation(s). Often or almost totally unable
to overcome this fear. Very marked impact on well being.

4. Overall Severity of Physical Symptoms of Anxiety

Not applicable 8
Does not know 9
None. No physical symptoms of anxiety. 0

Minimal: Very transient physical symptoms of anxiety. Symptoms are not, 1

or are hardly noticeable by others. Not clinically significant.

Mild: Few physical symptoms: no lasting impact. 2

` Borderline clinical significance. Intermediate between 1and 3.

Moderate: Persistent physical symptoms of anxiety, especially during exposure 3

to the feared situation(s). Symptoms are noticeable by others and significantly
interfere with his/her ability to function in the situation.

Severe: Marked physical symptoms of substantial clinical significance. 4

Intermediate between 3 and 5.

Extreme: Severe and persistent physical symptoms of anxiety, especially during 5

exposure to the feared situations(s). Symptoms are very obvious to others
and often result in inability to function in the situation.

5. Overall Avoidance of Anxiety-Provoking Situations

NOTE: Rate all avoidance here; include school, home, activities, etc. in rating

Not applicable 8
Does not know 9
None. Does not avoid the anxiety-provoking situation(s). 0

Minimal: Very occasionally avoids the anxiety-provoking situation(s). 1

Avoided situation(s) is/are not critical to his/her well-being.

Mild: Avoids anxiety-provoking situation(s) some of the time 2

but no important situation is consistently avoided. Borderline
clinical significance. Intermediate between 1 and 3.
Moderate: Avoid anxiety-provoking situation(s) frequently. 3
At least one important situation is avoided.

Severe: Avoids anxiety-provoking situation most of the time 4

or more than one important situation is consistently avoided.
Intermediate between 3 and 5.

Extreme: Avoids all or almost all anxiety-provoking situations. 5

6. Interference with Family Relationships and/or Performance at Home

Not applicable 8
Does not know 9
None. No interference. 0

Minimal: Very transient interference. No impact on relationships 1

with family members or performance (tasks, etc.) at home.

Mild: Slight impact on relationships or performance outside of the home. 2

Borderline clinical significance. Intermediate between 1 and 3.

Moderate: Clear interference. Either performance of tasks at home or frequency 3

or quality of interaction with family members is affected: he/she might
withdraw from interaction, or might be avoided/rejected by family members,
or might have many conflicts with them.

Severe: Marked interference in relationships with family members and/or 4

performance at home. Of substantial clinical significance.
Intermediate between 3 and 5.

Extreme: Totally or almost totally unable to maintain appropriate family relationship 5

and/or function at home.

7. Interference with Peer and Adult Relationships &/or Performance Outside of Home.
NOTE: Out-of-home functioning includes school (not avoidance), activities, etc

Not applicable 8
Does not know 9
None. No interference. 0

Minimal: Very transient interference. No impact on relationships with peers 1

or teachers or other adults outside of the home. No impact on functioning
outside of home, e.g., attending and performing group activities.

Mild: Slight impact on relationships or performance outside of the home. 2

Borderline clinical significance. Intermediate between 1 and 3.

Moderate: Clear interference. Either performance outside of the home or frequency 3

or quality of peer or adult interactions is affected: he/she might withdraw
from interaction, or might be avoided/rejected by peers or adults, or might
have conflicts with them.
Severe: Marked interference in relationship with peers or adults outside of home 4
and/or performance outside of home. Of substantial clinical significance.
Intermediate between 3 and 5.

Extreme: Totally or almost totally unable to maintain appropriate peer or 5

adult relationship and/or function outside of home.