SDQ FORM Parent report ages 4-10

SDQ FORM

Parent Report ages 4-10
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 6 months.
Your Childs Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Therapist you’re scheduled with*

First NameLast Name
Considerate of other people's feelings

Not TrueSomewhat TrueCertainly True
Restless, overactive, cannot stay still for long

Not TrueSomewhat TrueCertainly True
Shares readily with other children, for example toys, treats, pencils

Not TrueSomewhat TrueCertainly True
Often loses temper

Not TrueSomewhat TrueCertainly True
Rater solitary, prefers to play alone

Not TrueSomewhat TrueCertainly True
Generally well behaved, usually does what adults request

Not TrueSomewhat TrueCertainly True
Many worries or often seems worried

Not TrueSomewhat TrueCertainly True
___________________________________________________________________
Helpful if someone is hurt, upset or feeling ill

Not TrueSomewhat TrueCertainly True
Constantly fidgeting or squirming

Not TrueSomewhat TrueCertainly True
Has at least one good friend

Not TrueSomewhat TrueCertainly True
Often fights with other children or bullies them

Not TrueSomewhat TrueCertainly True
Often unhappy, depressed or tearful

Not TrueSomewhat TrueCertainly True
Generally liked by other children

Not TrueSomewhat TrueCertainly True
Easily distracted, concentration wanders

Not TrueSomewhat TrueCertainly True
Nervous or clingy in new situations, easily loses confidence

Not TrueSomewhat TrueCertainly True
___________________________________________________________________
Kind to younger children

Not TrueSomewhat TrueCertainly True
Often lies or cheats

Not TrueSomewhat TrueCertainly True
Picked on or bullied by other children

Not TrueSomewhat TrueCertainly True
often offers to help others (parents, teachers, other children)

Not TrueSomewhat TrueCertainly True
Thinks things out before acting

Not TrueSomewhat TrueCertainly True
Steals from home, school or elsewhere

Not TrueSomewhat TrueCertainly True
Gets along better with adults than with other children

Not TrueSomewhat TrueCertainly True
Many fears, easily scared

Not TrueSomewhat TrueCertainly True
Good attention pan, sees chores or homework through to the end

Not TrueSomewhat TrueCertainly True
Do you have any other comments or concerns?
Overall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behavior or being able to get on with other people?

NoYes- minor difficultiesYes- definite difficultiesYes- severe difficulties
If you have answered "yes", please answer the following questions about these difficulties:
How long have these difficulties been present?

Less than a month1-5 months6-12 monthsOver a year
Do the difficulties upset or distress your child?

Not at allOnly a littleA medium amountA great deal
Do the difficulties interfere with your child's everyday home life?

Not at allOnly a littleA medium amountA great deal
Do the difficulties interfere with your child's everyday friendships?

Not at allOnly a littleA medium amountA great deal
Do the difficulties interfere with your child's everyday classroom learning?

Not at allOnly a littleA medium amountA great deal
Do the difficulties interfere with your child's everyday leisure activities?

Not at allOnly a littleA medium amountA great deal
Do the difficulties put a burden on your or the family as a whole?

Not at allOnly a littleA medium amountA great deal
Signature

Clear
Date

MonthDayYear
Date
Relation to child
Should be Empty: