Circle one answer for each sentence.

1.- Many times I feel disgust or nausea Yeah No

CMASR-2
2.- I am very nervous Yeah No

Questionnaire-Profile 3.- I often worry that something bad will happen to me. Yeah No
Cecil R. Reynolds.PhD, and Bert O. Richmond Ed. d

4.- I am afraid that other children will laugh at me during class Yeah No
Date:___________________________ Name:
5.- I have too many headaches Yeah No
Age: __________ Degree:___________
___ Feminine ___ sculino - - 6.- I worry that others will not like me Yeah No

7.- Sometimes I wake up scared Yeah No

Instructions: 8.- People make me nervous Yeah No

The sentences that appear on this form tell
how some people think and feel about 9.- I feel like someone is going to tell me that I do things wrong Yeah No
themselves.
Read each sentence carefully and then 10.- I am afraid that others will laugh at me Yeah No
circle the word that corresponds to your
answer. 11.- It is difficult for me to make decisions Yeah No

Circle the word YES if you think that's who

12.- I get nervous when things don't go the way I want Yeah No
you are.
Circle the word NO if you think you are not 13.- It seems that things are easier for others than for me Yeah No
like that.
Respond to each sentence, even if you find 14.- I like all the people I know Yeah No
it difficult to choose an answer that applies
to you. 15.- Many times I feel like I'm short of breath. Yeah No
Do not check YES and NO for the same
16.- Almost all the time I am worried Yeah No
sentence. If you want to change your
answer, mark an X above your first answer 17.- I feel bad if people laugh at me. Yeah No
and then circle your new choice.
There are no right or wrong answers, only 18.- Many things scare me Yeah No
you can tell us how you think and feel about
yourself. Remember, after reading each 19.- I am always kind Yeah No

sentence ask yourself: Is it true in my case?

20.- I get angry easily Yeah No
If not, circle YES, if not, circle NO.
21.- I am worried about what my parents are going to tell me Yeah No

22.- I feel that others don't like how I do things Yeah No

23.- I am afraid to speak out loud in front of my classmates during
Yeah No
class.

24.- I always behave well Yeah No

DEF FIS INQ S.O.C.

Natural score/reactives from 1 to 24
 Circle one answer for each sentence.

CMASR-2 25.- At night it is difficult for me to fall asleep (a)

Yea
No
h
Yea
26.- I worry about what people think of me No
h
Yea
27.- I feel alone even if I am accompanied No
h
Inconsistent Response Index (INC)
Yea
To calculate the Inconsistent Response Index 28.- At school they make fun of me No
h
(INC) score, follow the instructions as indicated Yea
29.- I am always good No
in the manual. h
Yea
30.- It is very easy to hurt my feelings No
h
INC reagent pairs Add to INC Score Yea
31.- My hands sweat No
h
2 ________ 8_____________ tickwithout are
Yea
different 32.- I worry about making mistakes in front of people No
h
3 _______ 35_____________ tickwithout are Yea
33.- I am always nice to everyone No
h
different
Yea
34.- I get very tired No
4 _______ 10_____________ tickwithout are h
different Yea
35.- I am worried about what is going to happen No
h
6 _______ 49_____________ tickwithout are Yea
36.- Others are happier than me No
different h
Yea
7 _______ 39_____________ tickwithout are 37.- I am afraid to speak loudly in front of a group. No
h
different
Yea
38.- I always tell the truth No
19_______ 33_____________ tickwithout are h
______different Yea
39.- I have nightmares No
h
23_______ 37_____________ tickwithout are Yea
40.- Sometimes I get angry No
______different h
Yea
24_______ 29_____________ tickwithout are 41.- I am worried that during class they will make me participate No
h
______different Yea
42.- I feel worried when I go to sleep at night No
h
38_______ 48_____________ tickwithout are
Yea
________equal 43.- I have a hard time concentrating on my schoolwork. No
h
Yea
44.- Sometimes I say things I shouldn't say No
h
INC Index Score __________
Yea
45.- I am worried that someone will beat me up No
h
Yea
46.- I move a lot in my seat No
h
Yea
47.- Many people are against me No
h
Yea
48.- I have told a lie No
h
Yea
49.- I am worried about saying something stupid No
h

DEF FIS INQ S.O.C.

Natural score/reactives from 1 to 24
Natural score/reactives from 25 to
49
Total natural score

Total ____+_____+_____ --
 RATING TEMPLATE
CMASR-2

DEF FIS INQ S.O.C. DEF FIS INQ S.O.C.

1 25

2 26

3 27

4 28

5 29

6 30

7 31

8 32

9 33

10 34

11 35

12 36

13 37

14 38

15 39

16 40

17 41

18 42

19 43

20 44

21 45

22 46

23 47

24 48

49
Suggested Qualitative Descriptors for CMASR-2 Score Ranges
Score range Descriptor
71 and older Extremely anxious
61-70 Moderately anxious
No more anxious than most students
40-60

Less anxious than most students

39 and under

Score range Descriptor

35-49 Extremely high

28-34 High anxiety level

21-27 Moderate anxiety

20 or less Low anxiety level