Strenghts & Difficulties Questionnaire

Initial / Under 18 / Parent-Teacher-Guardian

For each item, please mark the box for Not True, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not absolutely certain or the item seems daft! Please give your answers on the basis of the child's behaviour over the last six months.

Child's Full Name

Sex

Male

Female

Child's Date of Birth

Day

Month

Year

Considerate of other people's feelings

Not True

Somewhat True

Certainly True

Restless, overactive, cannot stay still for long

Not True

Somewhat True

Certainly True

Often complains of headaches, stomach-aches or sickness

Not True

Somewhat True

Certainly True

Shares readily with other children (treats, toys, pencils etc)

Not True

Somewhat True

Certainly True

Often has temper tantrums or hot tempers

Not True

Somewhat True

Certainly True

Rather solitary, tends to play alone

Not True

Somewhat True

Certainly True

Generally obedient, usually does what adults request

Not True

Somewhat True

Certainly True

Many worries, often seems worried

Not True

Somewhat True

Certainly True

Helpful if someone is hurt, upset or feeling ill

Not True

Somewhat True

Certainly True

Constantly fidgeting or squirming

Not True

Somewhat True

Certainly True

Has at least one good friend

Not True

Somewhat True

Certainly True

Often fights with other children or bullies them

Not True

Somewhat True

Certainly True

Often unhappy, down-hearted or tearful

Not True

Somewhat True

Certainly True

Generally liked by other children

Not True

Somewhat True

Certainly True

Easily distracted, concentration wanders

Not True

Somewhat True

Certainly True

Nervous or clingy in new situations, easily loses confidence

Not True

Somewhat True

Certainly True

Kind to younger children

Not True

Somewhat True

Certainly True

Often lies or cheats

Not True

Somewhat True

Certainly True

Picked on or bullied by other children

Not True

Somewhat True

Certainly True

Often volunteers to help others (parents, teachers, other children)

Not True

Somewhat True

Certainly True

Thinks things out before acting

Not True

Somewhat True

Certainly True

Steals from home, school or elsewhere

Not True

Somewhat True

Certainly True

Gets on better with adults than with other children

Not True

Somewhat True

Certainly True

Many fears, easily scared

Not True

Somewhat True

Certainly True

Sees tasks through to the end, good attention span

Not True

Somewhat True

Certainly True

Do you have any other comments or concerns?

Overall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people?

No

Yes - minor difficulties

Yes - definite difficulties

Yes - severe difficulties

What is your relationship to the child?

Mother

Father

Other

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