Strengths and Difficulties Questionnaire

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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 six months.

First and last name

Date of birth

Date

Gender

MaleFemale

	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?

Overall, do you think that you have difficulties in any of the following areas: emotions, concentration, behavior, or being able to get on with other people>

NoYes - minor difficultiesYes - definite difficultiesYes - severe difficulties

How long have these difficulties been present?

Less than a month1-5 months6-12 monthsOver a year

Do the difficulties upset or distress you?

Not at allOnly a littleA medium amountA great deal

Do the difficulties interfere with your every day life in the following areas?

	Not at all	Only a little	A medium amount	A great deal
Home Life
Friendships
Classroom Learning
Leisure Activities

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

Not at allOnly a littleA medium amountA great deal

Your Signature

Today's Date

Date

Thank you very much for your help