Youth Test

Pediatric Symptom Checklist - Youth Report

Please mark under the heading that best fits you.

Complain of aches or pains
Spend more time alone
Tire easily, little energy
Fidgety, unable to sit still
Have trouble with teacher
Less interested in school
Act as if driven by motor
Daydream too much
Distract easily
Are afraid of new situations
Feel sad, unhappy
Are irritable, angry
Feel hopeless
Have trouble concentrating
Less interested in friends
Fight with other children
Absent from school
School grades dropping
Down on yourself
Visit doctor with doctor finding nothing wrong
Have trouble sleeping
Worry a lot
Want to be with parent more than before
Feel that you are bad
Take unnecessary risks
Get hurt frequently
Seem to be having less fun
Act younger than children your age
Do not listen to rules
Do not show feelings
Do not understand other people's feelings
Tease others
Blame others for your troubles
Take things that do not belong to you
Refuse to share
Do you have any emotional or behavioral problems for which you need help?