under 18 / Self | 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 or the item seems daft! Please give your answers on the basis of how things have been for you over the last six months.

Full Name

Date of Birth

Sex

Male

Female

I try to be nice to other people. I care about their feelings

Not True

Somewhat True

Certainly True

I am restless, I cannot stay still for long

Not True

Somewhat True

Certainly True

I get a lot of headaches, stomach-aches or sickness

Not True

Somewhat True

Certainly True

I usually share with others (food, games, pens etc.)

Not True

Somewhat True

Certainly True

I get very angry and often lose my temper

Not True

Somewhat True

Certainly True

I am usually on my own. I generally play alone or keep to myself

Not True

Somewhat True

Certainly True

I usually do as I am told

Not True

Somewhat True

Certainly True

I worry a lot

Not True

Somewhat True

Certainly True

I am helpful if someone is hurt, upset or feeling ill

Not True

Somewhat True

Certainly True

I am constantly fidgeting or squirming

Not True

Somewhat True

Certainly True

I have one good friend or more

Not True

Somewhat True

Certainly True

I fight a lot. I can make other people do what I want

Not True

Somewhat True

Certainly True

I am often unhappy, down-hearted or tearful

Not True

Somewhat True

Certainly True

Other people my age generally like me

Not True

Somewhat True

Certainly True

I am easily distracted, I find it difficult to concentrate

Not True

Somewhat True

Certainly True

I am nervous in new situations. I easily lose confidence

Not True

Somewhat True

Certainly True

I am kind to younger children

Not True

Somewhat True

Certainly True

I am often accused of lying or cheating

Not True

Somewhat True

Certainly True

Other children or young people pick on me or bully me

Not True

Somewhat True

Certainly True

I often volunteer to help others (parents, teachers, children)

Not True

Somewhat True

Certainly True

I think before I do things

Not True

Somewhat True

Certainly True

I take things that are not mine from home, school or elsewhere

Not True

Somewhat True

Certainly True

I get on better with adults than with people my own age

Not True

Somewhat True

Certainly True

I have many fears, I am easily scared

Not True

Somewhat True

Certainly True

I finish the work I'm doing. My attention is good

Not True

Somewhat True

Certainly True

Do you have any other comments or concerns?

Overall, do you think that you have 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 you?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties interfere with your home life?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties interfere with your everyday life in your friendships?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties interfere with your everyday life in your classroom learning?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties interfere with your everyday life in your leisure activities?

Not at all

Only a little

Quite a lot

A great deal

Do the difficulties make it harder for those around you (family, friends, teachers, etc.)?

Not at all

Only a little

Quite a lot

A great deal

Signature

Strenghts+Difficulties Questionnaire (SDQ)

Self-Assessment (Under 18)

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