Strengths and Difficulties Questionnaire (Self)

Evergreen Youth & Family Services

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 items as best you 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.
Client Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender

MaleFemale

Please answer to the best of your ability.*

	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 e 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 cam 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 then with people my own age.
I have many fears, I am easily scared.
I finish the work I'm doing. My attention is good.

Evergreen Youth & Family Services