1. Complains of aches and pains
Select
1
2
3
4
5
2. Spends more time alone lately
Select
1
2
3
4
5
3. Tires easily and/or has little energy
Select
1
2
3
4
5
4. Fidgety, unable to sit still
Select
1
2
3
4
5
5. Has trouble with teacher(s)
Select
1
2
3
4
5
6. Less interested in school
Select
1
2
3
4
5
7. Acts as if driven by a motor
Select
1
2
3
4
5
8. Daydreams too much
Select
1
2
3
4
5
9. Is afraid of (reluctant to go into) new situations
Select
1
2
3
4
5
10. Distracted easily
Select
1
2
3
4
5
11. Expresses feelings of sadness, unhappiness
Select
1
2
3
4
5
12. Has trouble concentrating
Select
1
2
3
4
5
13. Expresses feelings of hopelessness, despair
Select
1
2
3
4
5
14. Is irritable, angry
Select
1
2
3
4
5
15. Less interested in friends
Select
1
2
3
4
5
16. Fights with others
Select
1
2
3
4
5
17. Absent from school
Select
1
2
3
4
5
18. School grades dropping
Select
1
2
3
4
5
19. Expresses feelings of self doubt and low self worth
Select
1
2
3
4
5
20. Visits doctors who find nothing wrong
Select
1
2
3
4
5
21. Has trouble sleeping
Select
1
2
3
4
5
22. New friends of a different character/values than in the past
Select
1
2
3
4
5
23. Wants to be with you more
Select
1
2
3
4
5
24. Expresses thoughts/feelings that s/he is bad
Select
1
2
3
4
5
25. Takes unnecessary risks
Select
1
2
3
4
5
26. More slovenly/messy appearance and habits
Select
1
2
3
4
5
27. Sleeps more than before
Select
1
2
3
4
5
28. Worries a lot
Select
1
2
3
4
5
29. Gets hurt frequently
Select
1
2
3
4
5
30. Wears clothes that cover up most of the body
Select
1
2
3
4
5
31. Seems to be having less fun
Select
1
2
3
4
5
32. Acts less mature than children of the same age
Select
1
2
3
4
5
33. Does not listen to rules
Select
1
2
3
4
5
34. Is uncooperative at home and/or school (circle)
Select
1
2
3
4
5
35. Does not show feelings
Select
1
2
3
4
5
36. Does not understand and/or empathize with other's feelings
Select
1
2
3
4
5
37. Teases, picks on others
Select
1
2
3
4
5
38. Blames others for his/her troubles
Select
1
2
3
4
5
39. Seems to be too emotional
Select
1
2
3
4
5
40. Takes things that are not his/hers without asking
Select
1
2
3
4
5
41. Refuses to share
Select
1
2
3
4
5
42. Doesn't want to be with you or the family
Select
1
2
3
4
5
43. Is sarcastic and/or belittling others' values
Select
1
2
3
4
5
44. Comes late and/or procrastinates about tasks and respon-
sibilities more than before
Select
1
2
3
4
5
45. Exudes an attitude of nonchalance and "I don't care"
Select
1
2
3
4
5
