Strengths and Difficulties Questionnaire Follow-Up S (11-17) New

Your name *

Date of birth *

Date

Gender

Male Female

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 month. *

Not True

Somewhat True

Certainly True

I try to be nice to other people. I care about their feelings

I am restless, I cannot stay still for long

I get a lot of headaches, stomach-aches or sickness

I usually share with others, for example CD’s, games, food

I get very angry and often lose my temper

I would rather be alone than with people of my age

I usually do as I am told

I worry a lot

I am helpful if someone is hurt, upset or feeling ill

I am constantly fidgeting or squirming

I have one good friend or more

I fight a lot. I can make other people do what I want

I am often unhappy, depressed or tearful

Other people my age generally like me

I am easily distracted, I find it difficult to concentrate

I am nervous in new situations. I easily lose confidence

I am kind to younger children

I am often accused of lying or cheating

Other children or young people pick on me or bully me

I often offer to help others (parents, teachers, children)

I think before I do things

I take things that are not mine from home, school or elsewhere

I get along better with adults than with people my own age

I have many fears, I am easily scared

I finish the work I'm doing. My attention is good

Do you have any other comments or concerns?

Since coming to the clinic, are your problems: *

Much Worse A bit worse About the Same A bit better Much Better

Has coming to the clinic been helpful in other ways, e.g. providing information or making the problems more bearable? *

Not at all Only a little A medium amount A great deal

Over the last month, have you had difficulties in one or more 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:

Do the difficulties upset or distress you?

Not at all Only a little A medium amount A great deal

Do the difficulties interfere with your everyday life in the following areas?

Not at all

Only a little

A medium amount

A great deal

Home Life

Friendships

Learning

Leisure Activities

Do the difficulties make it harder for those around you (family, friends, teachers, etc.)?

Not at all Only a little A medium amount A great deal

Signature *

Clear

Date