Strength and Difficulties Questionnaire 11-17 Years

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Strength and Difficulties Questionnaire 11-17 years

* Indicates required field

Full name of client *

Email address *

Today's date *

Instructions: Please answer all the items to the best that you can even if you are not absolutely certain. Please give your answers on the basis of your child's behaviour over the last six months.

1. Considerate of other people's feelings *

Not true Somewhat true Certainly true

2. Restless, overactive, cannot stay still for long *

Not true Somewhat true Certainly true

3. Often complains of headaches, stomach-aches, or sickness *

Not true Somewhat true Certainly true

4. Shares readily with other people, for example CD's, games, food *

Not true Somewhat true Certainly true

5. Often loses temper *

Not true Somewhat true Certainly true

6. Would rather be alone than with other young people *

Not true Somewhat true Certainly true

7. Generally well behaved, usually does what adults request *

Not true Somewhat true Certainly true

8. Many worries or often seems worried *

Not true Somewhat true Certainly true

9. Helpful if someone is hurt, upset or feeling ill *

Not true Somewhat true Certainly true

10. Constantly fidgeting or squirming *

Not true Somewhat true Certainly true

11. Has at least one good friend *

Not true Somewhat true Certainly true

12. Often fights with other young people or bullies them *

Not true Somewhat true Certainly true

13. Often unhappy, depressed or tearful *

Not true Somewhat true Certainly true

14. Generally liked by other young people *

Not true Somewhat true Certainly true

15. Easily distracted, concentration wanders *

Not true Somewhat true Certainly true

16. Nervous in new situations, easily loses confidence *

Not true Somewhat true Certainly true

17. Kind to younger children *

Not true Somewhat true Certainly true

18. Often lies or cheats *

Not true Somewhat true Certainly true

19. Picked on or bullied by other young people *

Not true Somewhat true Certainly true

20. Often volunteers to help others (parents, teachers, children) *

Not true Somewhat true Certainly true

21. Thinks things out before acting *

Not true Somewhat true Certainly true

22. Steals from home, school or elsewhere *

Not true Somewhat true Certainly true

23. Gets along better with adults than with other young people *

Not true Somewhat true Certainly true

24. Many fears, easily scared *

Not true Somewhat true Certainly true

25. Good attention span, sees chores or homework through to the end *

Not true Somewhat true Certainly true

Over the last six months, have your child's teacher complained of:

36. Fidgetiness, restlessness or overactivity *

No A little A lot

37. Poor concentration or being easily distracted *

No A little A lot

38. Acting without thinking, frequently butting in or not waiting for his or her turn *

No A little A lot

26. Overall, do you think that your child has difficulties in any of the following areas: emotions, concentration, behaviour or being able to get along with other people? *

No Yes - minor difficulties Yes - definite difficulties Yes - severe difficulties

If you have answered "Yes", please answer the following questions about these difficulties

27. How long have these difficulties been present? *

Less than a month 1-5 months 6-12 months Over a year

28. Do the difficulties upset or distress your child? *

Not at all A little A medium amount A great deal

29. HOME LIFE *

Not at all A little A medium amount A great deal

30. FRIENDSHIPS *

Not at all A little A medium amount A great deal

31. CLASSROOM LEARNING *

Not at all A little A medium amount A great deal

32. LEISURE ACTIVITIES *

Not at all A little A medium amount A great deal

33. Do the difficulties put a burden on you or the family as a whole? *

Not at all A little A medium amount A great deal

Submit

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