Hamilton Anxiety Rating Scale (HAM-A)

Reference: Hamilton M.The assessment of anxiety states by rating. Br J Med Psychol 1959;
32:50–55.

Rating Clinician-rated Scoring

Administration time 10–15 minutes Each item is scored on a scale of 0 (not present) to 4
(severe), with a total score range of 0–56, where <17 indi-
Main purpose To assess the severity of symptoms
cates mild severity, 18–24 mild to moderate severity and
of anxiety
25–30 moderate to severe.
Population Adults, adolescents and children

Versions
Commentary
The scale has been translated into: Cantonese for China,
The HAM-A was one of the first rating scales developed French and Spanish. An IVR version of the scale is avail-
to measure the severity of anxiety symptoms, and is still able from Healthcare Technology Systems.
widely used today in both clinical and research settings.
The scale consists of 14 items, each defined by a series of
symptoms, and measures both psychic anxiety (mental Additional references
agitation and psychological distress) and somatic anxiety
Maier W, Buller R, Philipp M, Heuser I. The Hamilton
(physical complaints related to anxiety). Although the
Anxiety Scale: reliability, validity and sensitivity to
HAM-A remains widely used as an outcome measure in
change in anxiety and depressive disorders. J Affect
clinical trials, it has been criticized for its sometimes poor
Disord 1988;14(1):61–8.
ability to discriminate between anxiolytic and antidepres-
sant effects, and somatic anxiety versus somatic side Borkovec T and Costello E. Efficacy of applied
effects. The HAM-A does not provide any standardized relaxation and cognitive behavioral therapy in the
probe questions. Despite this, the reported levels of inter- treatment of generalized anxiety disorder. J Clin
rater reliability for the scale appear to be acceptable. Consult Psychol 1993; 61(4):611–19

Address for correspondence

The HAM-A is in the public domain.

81
 Hamilton Anxiety Rating Scale (HAM-A)

Below is a list of phrases that describe certain feeling that people have. Rate the patients by finding the answer which best describes the extent
to which he/she has these conditions. Select one of the five responses for each of the fourteen questions.

0 = Not present, 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Very severe.

1 Anxious mood 
0 
1 
2 
3 
4 8 Somatic (sensory) 
0 
1 
2 
3 
4
Worries, anticipation of the worst, fearful anticipation, irritability. Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness,
pricking sensation.
2 Tension 
0 
1 
2 
3 
4
Feelings of tension, fatigability, startle response, moved to tears
9 Cardiovascular symptoms 
0 
1 
2 
3 
4
easily, trembling, feelings of restlessness, inability to relax. Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting
feelings, missing beat.
3 Fears 
0 
1 
2 
3 
4
Of dark, of strangers, of being left alone, of animals, of traffic, of
10 Respiratory symptoms 
0 
1 
2 
3 
4
crowds. Pressure or constriction in chest, choking feelings, sighing, dyspnea.

4 Insomnia 
0 
1 
2 
3 
4 11 Gastrointestinal symptoms 
0 
1 
2 
3 
4
Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue Difficulty in swallowing, wind abdominal pain, burning sensations,
on waking, dreams, nightmares, night terrors. abdominal fullness, nausea, vomiting, borborygmi, looseness of
bowels, loss of weight, constipation.
5 Intellectual 
0 
1 
2 
3 
4
Difficulty in concentration, poor memory.
12 Genitourinary symptoms 
0 
1 
2 
3 
4
Frequency of micturition, urgency of micturition, amenorrhea,
6 Depressed mood 
0 
1 
2 
3 
4 menorrhagia, development of frigidity, premature ejaculation, loss of
libido, impotence.
Loss of interest, lack of pleasure in hobbies, depression, early waking,
diurnal swing.
13 Autonomic symptoms 
0 
1 
2 
3 
4
7 Somatic (muscular) 
0 
1 
2 
3 
4 Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension
headache, raising of hair.
Pains and aches, twitching, stiffness, myoclonic jerks, grinding of
teeth, unsteady voice, increased muscular tone.
14 Behavior at interview 
0 
1 
2 
3 
4
Fidgeting, restlessness or pacing, tremor of hands, furrowed brow,
strained face, sighing or rapid respiration, facial pallor, swallowing,
etc.

82
 Screen for Child Anxiety Related Disorders (SCARED)
CHILD Version—Page 1 of 2 (to be filled out by the CHILD)

Developed by Boris Birmaher, M.D., Suneeta Khetarpal, M.D., Marlane Cully, M.Ed., David Brent, M.D., and Sandra McKenzie, Ph.D.,
Western Psychiatric Institute and Clinic, University of Pittsburgh (October, 1995). E-mail: birmaherb@upmc.edu

See: Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child
Anxiety Related Emotional Disorders (SCARED): a replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10),
1230–6.

Name: __________________________________________ Date: __________________________________

Directions:
Below is a list of sentences that describe how people feel. Read each phrase and decide if it is “Not True or Hardly Ever True” or
“Somewhat True or Sometimes True” or “Very True or Often True” for you. Then, for each sentence, fill in one circle that
corresponds to the response that seems to describe you for the last 3 months.

0 1 2
Somewhat
Not True True or Very True
or Hardly Sometimes or Often
Ever True True True
1. When I feel frightened, it is hard to breathe O O O PN

2. I get headaches when I am at school. O O O SH

3. I don’t like to be with people I don’t know well. O O O SC

4. I get scared if I sleep away from home. O O O SP

5. I worry about other people liking me. O O O GD

6. When I get frightened, I feel like passing out. O O O PN

7. I am nervous. O O O GD

8. I follow my mother or father wherever they go. O O O SP

9. People tell me that I look nervous. O O O PN

10. I feel nervous with people I don’t know well. O O O SC

11. I get stomachaches at school. O O O SH

12. When I get frightened, I feel like I am going crazy. O O O PN

13. I worry about sleeping alone. O O O SP

14. I worry about being as good as other kids. O O O GD

15. When I get frightened, I feel like things are not real. O O O PN

16. I have nightmares about something bad happening to my parents. O O O SP

17. I worry about going to school. O O O SH

18. When I get frightened, my heart beats fast. O O O PN

19. I get shaky. O O O PN

20. I have nightmares about something bad happening to me. O O O SP

 Screen for Child Anxiety Related Disorders (SCARED)
CHILD Version—Page 2 of 2 (to be filled out by the CHILD)

0 1 2
Somewhat
Not True True or Very True
or Hardly Sometimes or Often
Ever True True True
21. I worry about things working out for me. O O O GD
22. When I get frightened, I sweat a lot. O O O PN
23. I am a worrier. O O O GD
24. I get really frightened for no reason at all. O O O PN
25. I am afraid to be alone in the house. O O O SP
26. It is hard for me to talk with people I don’t know well. O O O SC
27. When I get frightened, I feel like I am choking. O O O PN
28. People tell me that I worry too much. O O O GD
29. I don’t like to be away from my family. O O O SP
30. I am afraid of having anxiety (or panic) attacks. O O O PN
31. I worry that something bad might happen to my parents. O O O SP
32. I feel shy with people I don’t know well. O O O SC
33. I worry about what is going to happen in the future. O O O GD
34. When I get frightened, I feel like throwing up. O O O PN
35. I worry about how well I do things. O O O GD
36. I am scared to go to school. O O O SH
37. I worry about things that have already happened. O O O GD
38. When I get frightened, I feel dizzy. O O O PN
39. I feel nervous when I am with other children or adults and I have to do
something while they watch me (for example: read aloud, speak, play a O O O SC
game, play a sport).
40. I feel nervous when I am going to parties, dances, or any place where there
will be people that I don’t know well. O O O SC

41. I am shy. O O O SC

SCORING:
A total score of ≥ 25 may indicate the presence of an Anxiety Disorder. Scores higher than 30 are more specific. TOTAL =
A score of 7 for items 1, 6, 9, 12, 15, 18, 19, 22, 24, 27, 30, 34, 38 may indicate Panic Disorder or Significant Somatic
Symptoms. PN =
A score of 9 for items 5, 7, 14, 21, 23, 28, 33, 35, 37 may indicate Generalized Anxiety Disorder. GD =
A score of 5 for items 4, 8, 13, 16, 20, 25, 29, 31 may indicate Separation Anxiety SOC. SP =
A score of 8 for items 3, 10, 26, 32, 39, 40, 41 may indicate Social Anxiety Disorder. SC =
A score of 3 for items 2, 11, 17, 36 may indicate Significant School Avoidance. SH =
For children ages 8 to 11, it is recommended that the clinician explain all questions, or have the child answer the questionnaire sitting with an adult
in case they have any questions.

The SCARED is available at no cost at www.wpic.pitt.edu/research under tools and assessments, or at www.pediatric bipolar.pitt.edu under instruments.

March 27, 2012
 SPENCE CHILDREN’S ANXIETY SCALE

Your Name: Date:

PLEASE PUT A CIRCLE AROUND THE WORD THAT SHOWS HOW OFTEN EACH OF THESE THINGS
HAPPEN TO YOU. THERE ARE NO RIGHT OR WRONG ANSWERS.

1. I worry about things..........................................................……………… Never Sometimes Often Always

2. I am scared of the dark......................................................…………….. Never Sometimes Often Always
3. When I have a problem, I get a funny feeling in my stomach………... Never Sometimes Often Always
4. I feel afraid...................................................................………..………... Never Sometimes Often Always
5. I would feel afraid of being on my own at home......………………….... Never Sometimes Often Always
6. I feel scared when I have to take a test.......................…………………. Never Sometimes Often Always
7. I feel afraid if I have to use public toilets or bathrooms...........…………. Never Sometimes Often Always
8. I worry about being away from my parents......................………………. Never Sometimes Often Always
9. I feel afraid that I will make a fool of myself in front of people............... Never Sometimes Often Always
10. I worry that I will do badly at my school work...............…………………. Never Sometimes Often Always
11. I am popular amongst other kids my own age.................……………..... Never Sometimes Often Always
12. I worry that something awful will happen to someone in my family........ Never Sometimes Often Always
13. I suddenly feel as if I can’t breathe when there is no reason for this..... Never Sometimes Often Always
14. I have to keep checking that I have done things right (like the switch
is off, or the door is locked).....……………………………………………. Never Sometimes Often Always
15. I feel scared if I have to sleep on my own....................…………………. Never Sometimes Often Always
16. I have trouble going to school in the mornings because I feel nervous
or afraid...................................................…………………………………. Never Sometimes Often Always
17. I am good at sports....................................………………....................... Never Sometimes Often Always
18. I am scared of dogs.....................................................………………...... Never Sometimes Often Always
19. I can’t seem to get bad or silly thoughts out of my head...……………... Never Sometimes Often Always
20. When I have a problem, my heart beats really fast....………………….. Never Sometimes Often Always
21. I suddenly start to tremble or shake when there is no reason for this... Never Sometimes Often Always
22. I worry that something bad will happen to me...…........…………………. Never Sometimes Often Always
23. I am scared of going to the doctors or dentists.........…………………..... Never Sometimes Often Always
24. When I have a problem, I feel shaky...............................……………….. Never Sometimes Often Always
25. I am scared of being in high places or lifts (elevators)…………………. Never Sometimes Often Always
26. I am a good person......................................................…………..... Never Sometimes Often Always
27. I have to think of special thoughts to stop bad things from happening
(like numbers or words).......................………………………….… Never Sometimes Often Always
28 I feel scared if I have to travel in the car, or on a Bus or a train............. Never Sometimes Often Always
29. I worry what other people think of me......................…………………...... Never Sometimes Often Always
30. I am afraid of being in crowded places (like shopping centres, the
movies, buses, busy playgrounds)..........………………………………… Never Sometimes Often Always
31. I feel happy...............................................................................………….. Never Sometimes Often Always
32. All of a sudden I feel really scared for no reason at all…………………. Never Sometimes Often Always
33. I am scared of insects or spiders.....................................……………….. Never Sometimes Often Always
34. I suddenly become dizzy or faint when there is no reason for this......... Never Sometimes Often Always
35. I feel afraid if I have to talk in front of my class.....……………………….. Never Sometimes Often Always
36. My heart suddenly starts to beat too quickly for no reason…………….. Never Sometimes Often Always
37. I worry that I will suddenly get a scared feeling when there is nothing
to be afraid of....................................………………………………........… Never Sometimes Often Always
38. I like myself................................................................…………………….. Never Sometimes Often Always
39. I am afraid of being in small closed places, like tunnels or small rooms. Never Sometimes Often Always
40. I have to do some things over and over again (like washing my hands,
cleaning or putting things in a certain order)...…………………………... Never Sometimes Often Always
41. I get bothered by bad or silly thoughts or pictures in my mind…………. Never Sometimes Often Always
42. I have to do some things in just the right way to stop bad things
happening................................................…………………….…………... Never Sometimes Often Always
43. I am proud of my school work.......................................…….………….... Never Sometimes Often Always
44. I would feel scared if I had to stay away from home overnight…………. Never Sometimes Often Always
45. Is there something else that you are really afraid of?.....……………..…. YES NO
Please write down what it is

How often are you afraid of this thing?...........................………………… Never Sometimes Often Always

C
1994 Susan H. Spence
 The Spence Children’s
Anxiety Scale (SCAS) –
Parent version

Directions for use

Description
The scale consists of 38 anxiety items and one open-ended, non-scored item.
It provides an overall measure of anxiety together with scores on six sub-
scales each tapping a specific aspect of child anxiety.

Administration
The scale is completed by asking the parent to follow the instructions on the
printed form. The parent is asked to rate on a four-point scale – ‘never’,
‘sometimes’, ‘often’ or ‘always’ – how often each of the items happens to their
child. There is no set time period over which the judgement has to be made.
The response is made by circling the appropriate word.

Scoring
The responses are scored:
Never 0
Sometimes 1
Often 2
Always 3
This yields a maximum possible score of 114.

The sub-scale scores are computed by adding the individual item scores on
the set of items as follows:

Panic attack and 12 +19 +25 +27 +28 +30 +32 +33 +34
agoraphobia
Separation anxiety 5 +8 +11 +14 +15 +38
Physical injury fears 2 +16 +21 +23 +29
Social phobia 6 +7 +9 +10 +26 +31
Obsessive compulsive 13 +17 +24 +35 +36 +37
Generalized anxiety 1 +3 +4 +18 +20 +22
disorder / overanxious
disorder

The total score is the sum of all these six sub-scale scores.
 SPENCE CHILDREN’S ANXIETY SCALE
(Parent Report)

Your Name: Date:

Your Child’s Name:

BELOW IS A LIST OF ITEMS THAT DESCRIBE CHILDREN. FOR EACH ITEM PLEASE CIRCLE THE
RESPONSE THAT BEST DESCRIBES YOUR CHILD. PLEASE ANSWER ALL THE ITEMS.

1. My child worries about things.........................................................… Never Sometimes Often Always

2. My child is scared of the dark......................................................……. Never Sometimes Often Always
3. When my child has a problem, s(he) complains of
having a funny feeling in his / her stomach ……….............................. Never Sometimes Often Always

4. My child complains of feeling afraid...................................................... Never Sometimes Often Always

5. My child would feel afraid of being on his/her own at home………….... Never Sometimes Often Always
6. My child is scared when s(he) has to take a test..........…………………. Never Sometimes Often Always
7. My child is afraid when (s)he has to use public toilets or bathrooms.…. Never Sometimes Often Always
8. My child worries about being away from us / me..............………………. Never Sometimes Often Always
9. My child feels afraid that (s)he will make a fool of him/herself
in front of people..............…………….....…............……………............. Never Sometimes Often Always

10. My child worries that (s)he will do badly at school.........…………………. Never Sometimes Often Always
11. My child worries that something awful will happen to
someone in our family...................……….......…………...……………..... Never Sometimes Often Always

12. My child complains of suddenly feeling as if (s)he can't breathe

when there is no reason for this.............……….......…………...…………. Never Sometimes Often Always

13. My child has to keep checking that (s)he has done things right
(like the switch is off, or the door is locked).. ..........….........…………...... Never Sometimes Often Always
14. My child is scared if (s)he has to sleep on his/her own…………………… Never Sometimes Often Always
15. My child has trouble going to school in the mornings because
(s)he feels nervous or afraid....................…………………………………. Never Sometimes Often Always
16. My child is scared of dogs ......................…………………………………. Never Sometimes Often Always
17. My child can't seem to get bad or silly thoughts out of his / her head........ Never Sometimes Often Always
18. When my child has a problem, s(he) complains of
his/her heart beating really fast....................................………………...... Never Sometimes Often Always
19. My child suddenly starts to tremble or shake when there
is no reason for this...…….......................…...............................………... Never Sometimes Often Always

20. My child worries that something bad will happen to him/her…………….. Never Sometimes Often Always
21. My child is scared of going to the doctor or dentist ………………………. Never Sometimes Often Always
22. When my child has a problem, (s)he feels shaky…........…………………. Never Sometimes Often Always
23. My child is scared of heights (eg. being at the top of a cliff)........………... Never Sometimes Often Always
24. My child has to think special thoughts (like numbers or words)
to stop bad things from happening.....…............................……………… Never Sometimes Often Always

25. My child feels scared if (s)he has to travel in the

car, or on a bus or train …….......………...................……………………. Never Sometimes Often Always

26. My child worries what other people think of him/her..........…………..... Never Sometimes Often Always
27. My child is afraid of being in crowded places (like shopping centres,
the movies, buses, busy playgrounds).......................………………….… Never Sometimes Often Always
28 All of a sudden my child feels really scared for no reason at all............. Never Sometimes Often Always
29. My child is scared of insects or spiders.....................…………………...... Never Sometimes Often Always
30. My child complains of suddenly becoming dizzy or faint when
there is no reason for this..........…………………………………………… Never Sometimes Often Always
31. My child feels afraid when (s)he has to talk in front of the class.....…….. Never Sometimes Often Always
32. My child’s complains of his / her heart suddenly starting to
beat too quickly for no reason ……………………………………………… Never Sometimes Often Always

33. My child worries that (s)he will suddenly get a scared feeling
when there is nothing to be afraid of...........................…..……………….. Never Sometimes Often Always

34. My child is afraid of being in small closed places,

like tunnels or small rooms.........…..………........................…..………..... Never Sometimes Often Always

35. My child has to do some things over and over again (like washing
his / her hands, cleaning or putting things in a certain order).....………… Never Sometimes Often Always

36. My child gets bothered by bad or silly thoughts or pictures

in his/her head ………….…..………........................…...................…..… Never Sometimes Often Always
37. My child has to do certain things in just the right way to stop
bad things from happening ...............………………………………........… Never Sometimes Often Always
38. My child would feel scared if (s)he had to stay away from
home overnight..........................................................…………………….. Never Sometimes Often Always

39. Is there anything else that your child is really afraid of? .....…………..…. YES NO
Please write down what it is, and fill out how often (s)he is
afraid of this thing: ________________________________________ Never Sometimes Often Always
________________________________________________________ Never Sometimes Often Always
________________________________________________________ Never Sometimes Often Always

 2000 Susan H. Spence