First Name

Last Name


For each item, please select 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.

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 CDs, 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