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Behavioral Screen for Children
| Child's Name: | NEVER | SOMETIMES | OFTEN |
| Uncooperative, difficult to manage | |||
| Lying or cheating | |||
| Sad, cries for no apparent reason | |||
| Talks of suicide | |||
| Hyperactive, constantly moving | |||
| Short attention span | |||
| Complains of aches and pains | |||
| Cruel to animals | |||
| Refuses to share | |||
| Shows anger with violent actions, temper tantrums | |||
| Grades dropping in school | |||
| Slow to learn new things | |||
| Has trouble with a teacher | |||
| Experiments with alcohol or drugs, including inhalants (markers, gasoline, lighter fluid) | |||
| Smokes cigarettes | |||
| Takes unnecessary risks (playing with guns, sexually active, etc) | |||
| Spends too much time alone | |||
| Difficulty making friends | |||
| Tires easily, very little energy | |||
| Worries, seems nervous | |||
| Preoccupied with fears or phobias | |||
| Obsessive neatness or routines | |||
| Fights with other children | |||
| Does not show feelings | |||
| Has trouble sleeping | |||
| Acts too young for age | |||
| Gets teased or bullied at school | |||
| Threatens or bullies other people | |||
| Is afraid of new situations | |||
| Gets sick a lot |
Directions: Print this page on your printer, fill one out for each child, and bring to your pediatrician. Your doctor can help with some of these problems, and will tell you if further evaluation by a specialist is needed.
