Order Number SDQ for Parent or Teacher Followup Questionaire Date * Client's First Name * Client's Last Name * Client's Date of Birth * 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 this young person's behaviour over the last 6 months. 1. They are considerate of other people's feelings. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 2. Restless, overactive, cannot stay still for long. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 3. Often complains of headaches, stomach-aches or sickness * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 4. Shares readily with other children, for example books, games, food * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 5. Often loses temper. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 6. Would rather be/play alone than with other children. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 7. Generally well behaved, usually does what adults request. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 8. Many worries or often seems worried. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 9. Helpful if someone is hurt, upset or feeling ill. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 10. Constantly fidgeting or squirming. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 11. Has at least one good friend. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 12. Often fights with other children or bullies them * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 13. Often unhappy, depressed or tearful. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 14. Generally liked by other children. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 15. Easily distracted, concentration wanders. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 16. Nervious or clingy in new situations, easily loses confidence. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 17. Kind to younger children. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 18. Often lies or cheats. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 19. Picked on or bullied by other young people. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 20. Often volunteers to help others (parents, teachers, children). * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 21. Thinks things out before acting. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 22. Steals from home, school or elsewhere. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 23. Gets along better with adults than with other young people. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 24. Many fears, easily scared. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 25. Good attention span, sees chores or homework through to the end. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True Comments / Questions A. Since coming to the service your chilld's problems are: Much WorseA bit WorseAbout the SameA bit BetterMuch Better B. Has coming to the service been helpful in other ways, e.g. providing information or making the problems more bearable? Not at AllOnly a LittleQuite a LotA Great Deal C. Over the last month, has your child had difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? NoYes - Minor DifficultiesYes - Definite DifficultiesYes - Severe Difficulties D. Do the difficulties upset or distress your child? Not at AllOnly a LittleQuite a LotA Great Deal E. Do the difficulties interfere with your child's everyday life in the following areas? HOME LIFE Not at AllOnly a LittleQuite a LotA Great Deal FRIENDSHIPS Not at AllOnly a LittleQuite a LotA Great Deal CLASSROOM LEARNING Not at AllOnly a LittleQuite a LotA Great Deal LEISURE ACTIVITIES Not at AllOnly a LittleQuite a LotA Great Deal F. Do the difficulties put a burden on you or the family as a whole? Not at AllOnly a LittleQuite a LotA Great Deal Your feedback is important to us as it allows us to provide the best quality care and service for you the client. Please take a moment to fill in the following questionnaire. YesNo Thank you for taking the time complete the questionnaires. recaptcha
