*The following questions will help provide insight into what your child is experiencing, but are not intended as a diagnostic tool.

Emotional and physical health go together in children. Because parents are often the first to notice a problem with their child’s behavior, emotions, or learning, you may help your child get the best care possible by answering these questions. Please indicate which statement best describes your child.

Complains of aches and pains
Spends more time alone
Tires easily, has little energy
Fidgety, unable to sit still
Has trouble with teacher
Less interested in school
Acts as if driven by a motor
Daydreams too much
Distracted easily
Is afraid of new situations
Feels sad, unhappy
Is irritable, angry
Feels hopeless
Has trouble concentrating
Less interested in friends
Fights with other children
Absent from school
School grades dropping
Is down on him or herself
Visits the doctor with doctor finding nothing wrong
Has trouble sleeping
Worries a lot
Wants to be with you more than before
Feels he or she is bad
Takes unnecessary risks
Gets hurt frequently
Seems to be having less fun
Acts younger than children his or her age
Does not show feelings
Does not understand other people’s feelings
Teases others
Blames others for his or her troubles
Takes things that do not belong to him or her
Refuses to share

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