Strength and Difficulties Questionnaire Carer

Strength and Difficulties Questionnaire

For each item, please mark the box for Not True, Somewhat True and Certainly True. It would help us if you answered all items as best you can even if you are not absolutely certain or the item seems daft! Please give your answers on the basis of how things have been for you over the last 6 months.

Your name:

* required

Maximum 255 characters

0/255

Relationship:

* required

Maximum 255 characters

0/255

Child's name:

* required

Maximum 255 characters

0/255

Child's date of birth:

* required

Maximum 255 characters

0/255

Male/Female (choose as applicable)

* required

Male

Female

Considerate of other people’s feelings

* required

Not true

Somewhat true

Certainly true

Restless, overactive, cannot stay still for long

* required

Not true

Somewhat true

Certainly true

Often complains of headaches, stomach-aches or sickness

* required

Not true

Somewhat true

Certainly true

Shares readily with other children (food, games, pens, etc.)

* required

Not true

Somewhat true

Certainly true

10.

Often has temper tantrums or hot tempers

* required

Not true

Somewhat true

Certainly true

Other (please specify)

11.

Rather solitary, tends to play alone

* required

Not true

Somewhat true

Certainly true

12.

Generally obedient, usually does what adults request

* required

Not true

Somewhat true

Certainly true

13.

Many worries, often seems worried

* required

Not true

Somewhat true

Certainly true

14.

Helpful if someone is hurt, upset or feeling ill

* required

Not true

Somewhat true

Certainly true

15.

Constantly fidgeting or squirming

* required

Not true

Somewhat true

Certainly true

16.

Has at least one good friend

* required

Not true

Somewhat true

Certainly true

17.

Often fights with other children or bullies them

* required

Not true

Somewhat true

Certainly true

18.

Often unhappy, down-hearted or tearful

* required

Not true

Somewhat true

Certainly true

Other (please specify)

19.

Generally like by other children

* required

Not true

Somewhat true

Certainly true

20.

Easily distracted, concentration wanders

* required

Not true

Somewhat true

Certainly true

21.

Nervous or clingy in new situations, easily loses confidence

* required

Not true

Somewhat true

Certainly true

22.

Kind to younger children

* required

Not true

Somewhat true

Certainly true

23.

Often lies or cheats

* required

Not true

Somewhat true

Certainly true

24.

Picked on or bullied by other children

* required

Not true

Somewhat true

Certainly true

25.

Volunteers to help others (parents, teachers, other children)

* required

Not true

Somewhat true

Certainly true

26.

Thinks things out before acting

* required

Not true

Somewhat true

Certainly true

27.

Steals from from home, school or elsewhere

* required

Not true

Somewhat true

Certainly true

28.

Gets on better with adults than with other children

* required

Not true

Somewhat true

Certainly true

29.

Many fears, easily scared

* required

Not true

Somewhat true

Certainly true

Other (please specify)

30.

Sees tasks through to the end, good attention span

* required

Not true

Somewhat true

Certainly true

31.

Overall, do you think that the child has difficulties in one or more of the following areas:

Emotions, concentration, behaviour or being able to get on with other people?

* required

Yes – minor difficulties

Yes – definite difficulties

Yes – Severe difficulties

If you have answered “Yes”, please answer the following questions about these difficulties

32.

Do you have any other comments or concerns?

33.

Do the difficulties upset or distress the child?

* required

Not at all

Only a little

Quite a lot

A great deal

34.

Do the difficulties interfere with the child’s everyday life in the following areas?

* required

HOME LIFE

Not at all

Only a little

Quite a lot

A great deal

FRIENDSHIPS

Not at all

Only a little

Quite a lot

A great deal

CLASSROOM LEARNING

Not at all

Only a little

Quite a lot

A great deal

LEISURE ACTIVITIES

Not at all

Only a little

Quite a lot

A great deal

35.

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

* required

Not at all

Only a little

Quite a lot

A great deal

36.

How long have these difficulties been present?

* required

Less than a month

1-5 months

6-12 months

Over a year