Pediatric Symptom Checklist - Youth Report
The questionnaire that follows can be used to see if you are having emotional, attentional, or behavioral difficulties. For each item please mark how often you:
Complain of aches or pains
Never
Sometimes
Often
Error: *This field is required.
Spend more time alone
Never
Sometimes
Often
Error: *This field is required.
Tire easily, little energy
Never
Sometimes
Often
Error: *This field is required.
Fidgety, unable to sit still
Never
Sometimes
Often
Error: *This field is required.
Have trouble with teacher
Never
Sometimes
Often
Error: *This field is required.
Less interested in school
Never
Sometimes
Often
Error: *This field is required.
Act as if driven by motor
Never
Sometimes
Often
Error: *This field is required.
Daydream too much
Never
Sometimes
Often
Error: *This field is required.
Distract easily
Never
Sometimes
Often
Error: *This field is required.
Are afraid of new situations
Never
Sometimes
Often
Error: *This field is required.
Feel sad, unhappy
Never
Sometimes
Often
Error: *This field is required.
Are irritable, angry
Never
Sometimes
Often
Error: *This field is required.
Feel hopeless
Never
Sometimes
Often
Error: *This field is required.
Have trouble concentrating
Never
Sometimes
Often
Error: *This field is required.
Less interested in friends
Never
Sometimes
Often
Error: *This field is required.
Fight with other children
Never
Sometimes
Often
Error: *This field is required.
Absent from school
Never
Sometimes
Often
Error: *This field is required.
School grades dropping
Never
Sometimes
Often
Error: *This field is required.
Down on yourself
Never
Sometimes
Often
Error: *This field is required.
Visit doctor with doctor finding nothing wrong
Never
Sometimes
Often
Error: *This field is required.
Have trouble sleeping
Never
Sometimes
Often
Error: *This field is required.
Worry a lot
Never
Sometimes
Often
Error: *This field is required.
Want to be with parent more than before
Never
Sometimes
Often
Error: *This field is required.
Feel that you are bad
Never
Sometimes
Often
Error: *This field is required.
Take unnecessary risks
Never
Sometimes
Often
Error: *This field is required.
Get hurt frequently
Never
Sometimes
Often
Error: *This field is required.
Seem to be having less fun
Never
Sometimes
Often
Error: *This field is required.
Act younger than children your age
Never
Sometimes
Often
Error: *This field is required.
Do not listen to rules
Never
Sometimes
Often
Error: *This field is required.
Do not show feelings
Never
Sometimes
Often
Error: *This field is required.
Do not understand other people's feelings
Never
Sometimes
Often
Error: *This field is required.
Tease others
Never
Sometimes
Often
Error: *This field is required.
Blame others for your troubles
Never
Sometimes
Often
Error: *This field is required.
Take things that do not belong to you
Never
Sometimes
Often
Error: *This field is required.
Refuse to share
Never
Sometimes
Often
Error: *This field is required.
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