Instructions: For each item, please mark the box for Not True, Somewhat True, or Certainly True. Please answer on the basis of the child's behaviour over the last six months.
* Indicates required question
Considerate of other people's feelings *
Restless, overactive, cannot stay still for long *
Often complains of headaches, stomach-aches or sickness *
Shares readily with other children (treats, toys, pencils etc.) *
Often has temper tantrums or hot tempers *
Rather solitary, tends to play alone *
Generally obedient, usually does what adults request *
Many worries, often seems worried *
Helpful if someone is hurt, upset or feeling ill *
Constantly fidgeting or squirming *
Has at least one good friend *
Often fights with other children or bullies them *
Often unhappy, down-hearted or tearful *
Generally liked by other children *
Easily distracted, concentration wanders *
Nervous or clingy in new situations, easily loses confidence *
Kind to younger children *
Often lies or cheats *
Picked on or bullied by other children *
Often volunteers to help others (parents, teachers, other children) *
Thinks things out before acting *
Steals from home, school or elsewhere *
Gets on better with adults than with other children *
Many fears, easily scared *
Sees tasks through to the end, good attention span *
Overall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? *