Strengths and Difficulties Questionnaire (Parent 11-17)


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 your child's behavior over the last six months.

Your child's name    

 

Date of Birth

 

  Not
True
Somewhat
True
Certainly
True
Considerate of other people's feelings
Restless, overactive, cannot stay still for long
Often complains of headaches, stomach-aches or sickness
Shares readily with other youth, for example CD’s, games, food
Often loses temper
Would rather be alone than with other youth
Generally well behaved, usually does what adults request
Many worries or often seems worried
Helpful if someone is hurt, upset or feeling ill
Constantly fidgeting or squirming
Has at least one good friend
Often fights with other youth or bullies them
Often unhappy, depressed or tearful
Generally liked by other youth
Easily distracted, concentration wanders
Nervous or clingy in new situations, easily loses confidence
Kind to younger children
Often lies or cheats
Picked on or bullied by other youth
Often offers to help others (parents, teachers, other youth)
Thinks things out before acting
Steals from home, school or elsewhere
Gets along better with adults than with other children
Many fears, easily scared
Good attention span, sees chores or homework through to the end

 

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, behavior or being able to get on with other people?

 

If you have answered "Yes", please answer the following questions about these difficulties:

  • How long have these difficulties been present?

 

  • Do the difficulties upset or distress your child?

 

  • Do the difficulties interfere with your child's everyday life in the following areas?
  Not
at all
Only a
little
A medium
amount
A great
deal
HOME LIFE
FRIENDSHIPS
CLASSROOM LEARNING
LEISURE ACTIVITIES

 

  • Do the difficulties put a burden on you or the family as a whole?

 

Signature:   Date:

Mother/Father/Other (please specify:)

 

Thank you very much for your help

 

Leave this empty:

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Document name: Strengths and Difficulties Questionnaire (Parent 11-17)
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Timestamp Audit
September 21, 2021 7:40 am CSTStrengths and Difficulties Questionnaire (Parent 11-17) Uploaded by Roots Recovery - rootsforms@mncarepartner.com IP 206.84.188.12