Aiding Minds

Understanding minds & making a difference.

Please be honest and answer all questions, there are no right or wrong answers.

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* 1. Please state your schools name

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* 2. Form or class name

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* 3. What year group are you in

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* 4. Insert your full name

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* 5. Please state whether your

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* 6. Select one from each of the following question

I worry about things

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* 7. I feel sad or empty

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* 8. When I have a problem, I get a funny feeling in my stomach

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* 9. I worry when I think I have done poorly at something

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* 10. I would feel afraid of being on my own at home

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* 11. I like to be in control?

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* 12. Nothing is much fun anymore

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* 13. I feel scared when I have to take a test

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* 14. I feel worried when I think someone is angry with me

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* 15. I worry about being away from my parents

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* 16. I get bothered by bad or silly thoughts or pictures in my mind

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* 17. I have trouble sleeping

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* 18. I worry that I will do badly at my school work

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* 19. I worry that something awful will happen to someone in my family

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* 20. I suddenly feel as if I can't breathe when there is no reason for this

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* 21. I have problems with my appetite (eating habits)

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* 22. Have you ever used Calorie counting Apps or Apps to manage your weight.

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* 23. I have to keep checking that I have done things right (like checking if the switch is off, or the door is locked)

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* 24. I feel scared if I have to sleep on my own

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* 25. I have trouble going to school in the mornings because I feel nervous or afraid

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* 26. I have no energy for things

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* 27. I worry I might look foolish

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* 28. I am tired a lot

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* 29. I worry that bad things will happen to me

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* 30. I can't get bad or silly thoughts out of my head

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* 31. I have thoughts of self harm or suicide

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* 32. When I have a problem, my heart beats really fast

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* 33. I can not think clearly

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* 34. I suddenly start to tremble or shake when there is no reason for this

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* 35. I worry that something bad will happen to me

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* 36. When I have a problem, I feel shaky

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* 37. I feel worthless

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* 38. I worry about making mistakes

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* 39. I have to think of special thoughts (like numbers or words) to stop bad things from happening

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* 40. I worry what other people think of me

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* 41. I am afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds)

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* 42. I think about death

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* 43. All of a sudden I feel really scared for no reason at all

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* 44. I worry about what is going to happen

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* 45. I suddenly become dizzy or faint when there is no reason for this

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* 46. I have had thoughts of self harm or suicide 

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* 47. I feel afraid if I have to talk in front of my class

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* 48. My heart suddenly starts to beat too quickly for no reason

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* 49. I feel like I don’t want to move

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* 50. I worry that I will suddenly get a scared feeling when there is nothing to be afraid of

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* 51. I have to do some things over and over again (like washing my hands, cleaning or putting things in a certain order)

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* 52. I am afraid of looking foolish in front of people

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* 53. I have to do some things in just the right way to stop bad things from happening

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* 54. I worry in bed at night

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* 55. I feel scared if I have to sleep away from home overnight

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* 56. I feel restless

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* 57. Do you help/look after one of your parents or help care for a brother or sister or a relative who may have a Disability, Medical condition or Mental health  issues.

By doing extra jobs in and around the home, such as Cooking, cleaning, helping someone get dressed, move around the house, take medications or pick up drop off siblings from school.

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