Parent Screening

Pediatric Symptom Checklist

Please mark under the heading that best describes your child.

Feels sad, unhappy
Feels hopeless
Is down on self
Worries a lot
Seems to be having less fun
Fidgety, unable to sit still
Daydreams too much
Distracted easily
Has trouble concentrating
Acts as if driven by a motor
Fights with other children
Does not listen to rules
Does not understand other people’s feelings
Teases others
Blames others for his/her troubles
Refuses to share
Takes things that do not belong to him/her