Order Number SDQ Self Followup Questionaire Date * Your First Name * Your Last Name * Your 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. I try to be nice to other people. I care about their feelings. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 2. I am restless, I cannot stay still for long. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 3. I often get a lot of headaches, stomach-aches or sickness * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 4. I usually share with others, for example CD's, games, food * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 5. I get very angry and often lose my temper. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 6. I would rather be alone that with people of my age. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 7. I usually do as I am told. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 8. I worry a lot. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 9. I am 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. I am constantly fidgeting or squirming. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 11. I have one good friend or more. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 12. I fight a lot. I can make other people do what I want. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 13. I am often unhappy, depressed or tearful. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 14. Other people my age generally like me. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 15. I am easily distracted, I find it difficult to concentrate. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 16. I am nervous in new situations, I easily lose confidence. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 17. I am kind to younger children. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 18. I am often accused of lying or cheating. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 19. Other children or young people pick on me or bully me. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 20. I often volunteer to help others (parents, teachers, children). * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 21. I think before I do things. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 22. I take things that are not mine from home, school or elsewhere. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 23. I get along better with adults than with people my own age. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 24. I have many fears, I am easily scared. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True 25. I finish the work I'm doing. My attention is good. * Please select the appropriate response from the drop down menu. Not True Somewhat True Certainly True Comments / Questions A. Since coming to the service are your problems: 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, have you 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. Over the last month, have you 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 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 complete the following Client Feedback questionnaire. * YesNo Thank you for taking the time to complete the questionnaires. recaptcha
