CHECKLIST OF CONCERNS

Review the list below and check off all emotional/behavioral problems that you would attribute to your child. The spaces at the bottom are for adding any problems that do not appear on the list. Share | | print   Frequently steals   Is frequently angry or loses temper often   Frequently lies or is deceitful   Frequently argues with adults   Has run away from home   Is easily annoyed by others, highly irritable   Has deliberately set fires   Often blames others for his/her mistakes   Is truant from school   Often defies or ignores adult requests   Has broken into a car or dwelling   Refuses to follow directions or rules   Has deliberately destroyed another's property   Has a low frustration tolerance   Is physically cruel to others   Deliberately annoys or provokes others   Is physically cruel to animals   Avoids taking responsibility for behavior   Often initiates physical fights   Frequently swear or uses foul language   Has forced another into sexual activity   Is overly disrespectful to authority   Carries (or has carried) a weapon   Has no concern for consequences   Has used a weapon to hurt someone   Becomes destructive when angry   Has legal problems   Becomes aggressive/assaultive when angry   Has a history of drug, tobacco, or alcohol use   Is overly controlling of others   Appears to be influences by gangs   Has threatened to harm/kill others   Participates in gang activity   Doesn't get along well with others   Displays inappropriate/inconsistent emotions   Becomes vindictive when angry   Complains of "seeing things"      (visual hallucinations)   Engages in self-harming or self-mutilation   Complains of "hearing voices"      (auditory hallucinations)   Often attempts to manipulate others   Has bizarre thought processes   Often appears sad or depressed   Has homicidal thoughts/ideation   Withdraws or isolates from others   Has suicidal thoughts/ideation   Has feelings of worthlessness   Acts immaturely   Has a complete lack of motivation   Seeks negative attention   Often fidgets or squirms, can't sit still   Is overly preoccupied with sex   Is easily distracted   Acts out sexually   Has a difficult time following directions   Urinates or defecates in unusual places   Talks excessively at innapropriate times   Wets or soils self during the day   Has a difficult time following directions   Has problems at school   Often interrupts or intrudes on others   Has excessive anxiety and worry   Has a difficult time focusing on a task   Has a fear which disrupts daily life   Often acts impulsively (without thinking)   Often impedes on the rights of others   Has a difficult time playing quietly   Participates in dangerous/reckless behaviors   Often fails to complete chores or tasks OTHER: _________________________________________ OTHER: _________________________________________ OTHER: _________________________________________ If your child is receiving therapy, then this checklist may provide insight to the mental health professional that is caring for your child.