CAPABILITIES AND DIFFICULTIES QUESTIONNAIRE (SDQ-CAS)

Your child's name: Sex:

Date of birth: Evaluation Date:
Educational Institution: Level:
Grade: Section:
Please put a cross in the box that you think corresponds to each of the questions: not true, somewhat
true, absolutely true. It would be a great help to us if you would answer all the questions to the best
of your ability, even if you are not completely sure of the answer, or if it seems like an odd question
to you. Please answer the questions based on your child's behavior over the past six months.

Somewhat
Not true Absolutely true
true
1 Takes other people's feelings into account.
2 Restless, hyperactive, cannot sit still for long periods of time.
3 Frequently complains of headache, stomachache or nausea.
4 Frequently shares treats, toys, pencils, etc. with other children.
5 Frequently has temper tantrums or temper tantrums.
6 He/she is rather solitary and tends to play alone.
7 Generally obedient, he usually does what adults ask him to do.
8 Has many worries, often seems restless or preoccupied.
9 Offers help when someone is hurt, upset, or sick.
10 He is continually moving and is unruly.
11 Have at least one good friend.
12 Frequently fights with or picks on other children.
13 Often feels unhappy, discouraged or tearful.
14 The other children usually like him/her.
15 Easily distracted, his concentration tends to wander.
16 Is nervous or dependent in new situations, easily loses self-
confidence.
17 Treat younger children well.
18 Often shows a negative attitude to adults
19 Other children pick on him/her or tease him/her.
20 Often offers to help (parents, teachers, other children)
21 Has the ability to think before acting
22 Often shows resentment when angry
23 Gets along better with adults than with other children
24 He has many fears, he is easily frightened.
25 Finishes what he starts, has good concentration.
 IMPACT QUESTIONS

Do you think your child has difficulties in any of the following areas: emotions,
concentration, behavior, or ability to relate to others?

No Yes - minor Yes - clear Yes - severe

difficulties difficulties difficulties

If you answered "Yes", please answer the following questions about these difficulties:

 How long have you had these difficulties?

Less than 1-5 months 6-12 More than

one month months one year

 Do you think that these difficulties worry or cause discomfort to your child?

No Just a little Quite Much

 Do these difficulties interfere with your child's daily life in the following areas?

No Just a little Quite Much

Life at Home
Friendships
Learning
Leisure or free time activities

 Are these difficulties a burden to you or your family member?

No Just a little Quite Much

Firma................................................ Date...............................

Mother/father/other: (please indicate).....................................................

 FOLLOW-UP QUESTIONS

Since coming to the clinic, has your child been here?

Much A little About the A little Much

worse worse same better Better

Has coming to the clinic helped you in other ways. For example: providing information or
making problems more tolerable?
No Just a little Quite Much

In the last month. Do you think your child has had difficulties in any of the following areas:
emotions, concentration, behavior, or ability to relate to others?
No Yes - minor Yes - clear Yes - severe
difficulties difficulties difficulties

If you answered "Yes", please answer the following questions about these difficulties:
 Do you think these difficulties worry or cause discomfort to your child?

No Just a little Quite Much

 Do these difficulties interfere with your child's daily life in the following areas?
No Just a little Quite Much
Life at Home
Friendships
Learning
Leisure or free time activities
 Are these difficulties a burden to you or your family member?
No Just a little Quite Much

Firma................................................ Date...............................

Mother/father/other: (please indicate).....................................................

RESPONSE SHEET
 Somewhat
Not true Absolutely true
true
3 Frequently complains of headache, stomachache or nausea. 0 1 2
8 Has many worries, often seems restless or preoccupied. 0 1 2
13 Often feels unhappy, discouraged or tearful. 0 1 2
Is nervous or dependent in new situations, easily loses self-
16
confidence.
0 1 2
24 He has many fears, he is easily frightened. 0 1 2
EMOTIONAL PROBLEM SCALE - TOTAL
5 Frequently has temper tantrums or temper tantrums. 0 1 2
7 Generally obedient, he usually does what adults ask him to do. 2 1 0
12 Frequently fights with or picks on other children. 0 1 2
18 Often shows a negative attitude to adults 0 1 2
22 Often shows resentment when angry 0 1 2
BEHAVIORAL PROBLEMS SCALE - TOTAL
2 Restless, hyperactive, cannot sit still for long periods of time. 0 1 2
10 He is continually moving and is unruly. 0 1 2
15 Easily distracted, his concentration tends to wander. 0 1 2
21 Has the ability to think before acting 2 1 0
25 Finishes what he starts, has good concentration. 2 1 0
HYPERACTIVITY - TOTAL
6 He/she is rather solitary and tends to play alone. 0 1 2
11 Have at least one good friend. 2 1 0
14 The other children usually like him/her. 2 1 0
19 Other children pick on him/her or tease him/her. 0 1 2
23 Gets along better with adults than with other children 0 1 2
SCALE OF PROBLEMS WITH PEERS - TOTAL
1 Takes other people's feelings into account. 0 1 2
4 Frequently shares treats, toys, pencils, etc. with other children. 0 1 2
9 Offers help when someone is hurt, upset, or sick. 0 1 2
17 Treat younger children well. 0 1 2
20 Often offers to help (parents, teachers, other children) 0 1 2
PROSOCIAL SCALE - TOTAL
TOTAL SUM OF THE SCALES (*)

(*) In the total sum of the scales, the direct score of the Prosocial Scale is not counted.
 BAREMOS

Normal Limit Abnormal

Total score 0-13 14-16 17-40
Emotions Scale 0-3 4 5-10
Behavioral Problems Scale 0-2 3 4-10
Hyperactivity Scale 0-5 6 7-10
Peer Problems Scale 0-2 3 4-10
Prosocial Scale 6-10 5 0-4