Questionnaire

Parents: Strengths and Difficulties Questionnaire

Month
  • - select a option -
  • January
  • Feburary
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • November
  • October
  • December
Field is required!
Date:
  • - select a option -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Field is required!
Year
  • - select a option -
  • 1991
  • 1992
  • 1993
  • 1994
  • 1995
  • 1996
  • 1997
  • 1998
  • 1999
  • 2000
  • 2001
  • 2002
  • 2003
  • 2004
  • 2005
  • 2006
  • 2007
  • 2008
  • 2009
  • 2010
  • 2011
  • 2012
  • 2013
  • 2014
  • 2015
  • 2016
  • 2017
  • 2018
  • 2019
  • 2020
  • 2021
  • 2022
Field is required!
Child's Name
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Last Name
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Month
  • - select a option -
  • January
  • Feburary
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • November
  • October
  • December
Field is required!
Date:
  • - select a option -
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Field is required!
Year
  • - select a option -
  • 1991
  • 1992
  • 1993
  • 1994
  • 1995
  • 1996
  • 1997
  • 1998
  • 1999
  • 2000
  • 2001
  • 2002
  • 2003
  • 2004
  • 2005
  • 2006
  • 2007
  • 2008
  • 2009
  • 2010
  • 2011
  • 2012
  • 2013
  • 2014
  • 2015
  • 2016
  • 2017
  • 2018
  • 2019
  • 2020
  • 2021
  • 2022
Field is required!
Child's Gender
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Guardian/Parent Name:
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Last Name;
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Guardian E-mail Address:
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Strengths and Difficulties Questionnaire

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