11/13/2022 School Refusal Assessment Scale - Revised (P) Survey

School Refusal Assessment Scale - Revised (P)

Parents & Teachers

This questionnaire takes about 5 minutes to complete.

The School Refusal Assessment Scale is an evidence based assessment tool designed to evaluate school refusal
disorder symptoms in children and identify their reasons for avoiding school. The School Refusal Assessment
Scale was developed by Christopher Kearney and Wendy Silverman, Several research studies support the SRAS-
R as a reliable and valid measure of children’s school refusal symptoms.

1. How often does your child have bad feelings about going to school because
he/she is afraid of something related to school (for example, tests, school bus,
teacher, fire alarm)?
Never Seldom Sometimes Half the Time Usually Almost always Always

2. How often does your child stay away from school because it is hard for him/her to
speak with the other kids at school?
Never Seldom Sometimes Half the Time Usually Almost always Always

3. How often does your child feel he/she would rather be with you or your spouse
than go to school?
Never Seldom Sometimes Half the Time Usually Almost always Always

4. When your child is not in school during the week (Monday to Friday), how often
does he/she leave the house and do something fun?
Never Seldom Sometimes Half the Time Usually Almost always Always

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11/13/2022 School Refusal Assessment Scale - Revised (P) Survey

5. How often does your child stay away from school because he/she will feel sad or
depressed if he/she goes?
Never Seldom Sometimes Half the Time Usually Almost always Always

6. How often does your child stay away from school because he/she feels
embarrassed in front of other people at school?
Never Seldom Sometimes Half the Time Usually Almost always Always

7. How often does your child think about you or your spouse or family when in
school?
Never Seldom Sometimes Half the Time Usually Almost always Always

8. When your child is not in school during the week (Monday to Friday), how often
does he/she talk to or see other people (other than his/her family)?
Never Seldom Sometimes Half the Time Usually Almost always Always

9. How often does your child feel worse at school (for example, scared, nervous, sad)
compared to how he/she feels at home with friends?
Never Seldom Sometimes Half the Time Usually Almost always Always

10. How often does your child stay away from school because he/she does not have
many friends there?
Never Seldom Sometimes Half the Time Usually Almost always Always

11. How much would your child rather be with his/her family than go to school?
Never Seldom Sometimes Half the Time Usually Almost always Always

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11/13/2022 School Refusal Assessment Scale - Revised (P) Survey

12. When your child is not in school during the week (Monday to Friday), how much
does he/she enjoy doing different things (for example, being with friends, going
place)?
Never Seldom Sometimes Half the Time Usually Almost always Always

You're doing well, only 13 more questions to go!

13. How often does your child have bad feelings about school (for example, scared,
nervous, or sad) when he/she thinks about school on Saturday and Sunday?
Never Seldom Sometimes Half the Time Usually Almost always Always

14. How often does your child stay away from certain places in school (e.g.,
hallways, places where certain groups of people are) where he/she would have to
talk to someone?
Never Seldom Sometimes Half the Time Usually Almost always Always

15. How much would your child rather be taught by you or your spouse at home than
by his/her teacher at school?
Never Seldom Sometimes Half the Time Usually Almost always Always

16. How often does your child refuse to go to school because he/she wants to have
fun outside of school?
Never Seldom Sometimes Half the Time Usually Almost always Always

17. If you child has less bad feelings (for example, scared, nervous, sad) about
school, would it be easier for him/her to go to school?
Never Seldom Sometimes Half the Time Usually Almost always Always

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11/13/2022 School Refusal Assessment Scale - Revised (P) Survey

18. If it were easier for your child to make new friends, would it be easier for him/her
to go to school?
Never Seldom Sometimes Half the Time Usually Almost always Always

19. Would it be easier for your child to go to school if you or your spouse went with
him/her?
Never Seldom Sometimes Half the Time Usually Almost always Always

20. Would it be easier for your child to go to school if he/she could do more things
he/she likes to do after school hours (for example, being with friends)?
Never Seldom Sometimes Half the Time Usually Almost always Always

Only 5 more questions to go!

21. How much more does your child have bad feelings about school (for example,
scared, nervous, or sad) compared to other kids his/her age?
Never Seldom Sometimes Half the Time Usually Almost always Always

22. How often does your child stay away from people at school compared to other
kids his/her age?
Never Seldom Sometimes Half the Time Usually Almost always Always

23. Would your child like to be home with you or your spouse more than other kids
his/her age?
Never Seldom Sometimes Half the Time Usually Almost always Always

24. Would your child rather be doing fun things outside of school more than most kids
his/her age?
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11/13/2022 School Refusal Assessment Scale - Revised (P) Survey

Never Seldom Sometimes Half the Time Usually Almost always Always

* 25. Name (confidential)

Your Surname

Child's name

Child's surname

Child's age

Your Personal Email

Your Mobile or Home

26. I would like the School Refusal Clinic to call me back to discuss an appointment

don't forget to submit your results.

School Refusal Assessment Scale - Revised, Developed by Christopher Kearney and Wendy Silverman.

1. Kearney, C. A.; Silverman, W. K. (1993), "Measuring the function of school refusal behavior: The School
Refusal Assessment Scale", Journal of Clinical Child Psychology, 22 (1): 85–86
2. Kearney, C. A. (2002), "Identifying the function of school refusal behavior: A revision of the School Refusal
Assessment Scale", Journal of Psychopathology and Behavioral Assessment, 24 (4): 235–245
3. Kearney, C.A. (2006), "Confirmatory factor analysis of the School Refusal Assessment Scale-Revised: Child
and parent versions", Journal of Psychopathology and Behavioral Assessment, 28 (3): 139–144

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11/13/2022 School Refusal Assessment Scale - Revised (P) Survey

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