Strengths and Difficulties Questionnaire (Child 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 how things have been for you over the last six months.
Your name Male Female
Date of Birth
Do you have any other comments or concerns?
Overall, do you think that you have difficulties in any of the following areas:
emotions, concentration, behavior or being able to get on with other people?
No Yes - minor difficulties Yes - definite difficulties Yes - severe difficulties
If you have answered "Yes", please answer the following questions about these difficulties:
Less than a month 1-5 months 6-12 months Over a year
Not at all Only a little A medium amount A great deal
Signature: Today's Date:
Thank you very much for your help
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Your legal name
Your email address
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Document Name: Strengths and Difficulties Questionnaire (Child 11-17)
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