18+ / Informant | TRACK CLINIC

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. Please give your answers on the basis of how the person you are describing has been over the last six months.

Full name of the person you are describing

Sex

Male

Female

Date of Birth

Considerate of other people's feelings

Not True

Somewhat True

Certainly True

Restless, overactive, finds it hard to sit down 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 others, for example food and drink

Not True

Somewhat True

Certainly True

Often loses temper

Not True

Somewhat True

Certainly True

Would rather be alone than with other people

Not True

Somewhat True

Certainly True

Generally willing to do what other people want

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 others or bullies them

Not True

Somewhat True

Certainly True

Often unhappy, down-hearted or tearful

Not True

Somewhat True

Certainly True

Generally liked by others

Not True

Somewhat True

Certainly True

Easily distracted, concentration wanders

Not True

Somewhat True

Certainly True

Nervous in new situations, easily loses confidence

Not True

Somewhat True

Certainly True

Kind to children

Not True

Somewhat True

Certainly True

Often lies or cheats

Not True

Somewhat True

Certainly True

Picked on or bullied by others

Not True

Somewhat True

Certainly True

Often volunteers to help others (family members, friends, colleagues)

Not True

Somewhat True

Certainly True

Thinks things out before acting

Not True

Somewhat True

Certainly True

Steals from home, work or elsewhere

Not True

Somewhat True

Certainly True

Gets along better with older people than with people of his/her age

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 the person you are describing 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

How long have these difficulties been present?

Less than a month

1-5 months

6-12 months

Over a year

Do the difficulties upset or distress the person you are describing?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties interfere with this person's everyday life in getting along with the people he/she is closest to (e.g. family, partner)?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties interfere with this person's everyday life in making and keeping friends?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties interfere with this person's everyday life in work or study?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties interfere with this person's everyday life in his/her hobbies, sports or other leisure activities?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties put a burden on you or others?

Not at all

Only a little

Quite a lot

A great deal

What is your relationship to this person?

Signature

Strenghts+Difficulties Questionnaire (SDQ)

Informant Assessment (Over 18)

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