Instructions: 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're not absolutely certain or the item seems daft! Answer based on the child's behaviour over the last six months or this school year.
* 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 student has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? *