Complete this questionnaire if your child is six years or older. It is designed to help you determine if professional help is needed, and it is a guide not a diagnostic tool. Always seek immediate assistance if there is a threat of self-harm or harm to others. It is important to be calm and objective when completing the questionnaire. Describe your child as he or she is now (to understand your child's basic nature, refer to the "Do you have a difficult child?" questionnaire). Use the following rating scale:

0 = No problem (never present or just a little)
1 = Moderate problem (sometimes present)
2 = Definite problem (often present)
3 = Severe problem (nearly always or always present)

  Rate from 0 to 3

Anxious, nervous, worried

_________

Sad, cries easily

_________

Withdrawn, disinterested

_________

Says I am bad or stupid

_________

Too hard on himself

_________

Feelings easily hurt

_________

Reluctant to go to school

_________

Immature

_________

Inattentive, forgetful, disorganized

_________

Hyperactive, wild

_________

Easily frustrated

_________

Impulsive, acts without thinking

_________

Poor social skills

_________

Irritable or angry

_________

Defiant, oppositional

_________

Concerns about academic performance

_________

Concerns about drug or alcohol use

_________

“Addiction” to computer and video games

_________

Prolonged tantrums

_________

Extreme mood swings

_________

Rages that can be destructive

_________

What conclusions can you draw?

If you have given your child a high rating on a few items, or a moderatly high rating on several irtems, you should consider a professional evaluation.

 

Is your child having problems now?

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Staneley Turecki, MD