Client: Form: Parent SDQ Form

No. Item
1 Considerate
2 Restless
3 Headaches
4 Shares – Other children
5 Temper
6 Solitary – Plays alone
7 Usually, obedient
8 Many worries
9 Helpful if someone hurt
10 Fidget/ Squirming
11 At least one good friend
12 Fights other children
13 Unhappy/ downhearted
14 Liked by other children
15 Distracted
16 Nervous/ Clingy
17 Kind younger children
18 Often lies or cheats
19 Picked on/ bullied
20 Volunteers help other
21 Thinks before acting
22 Steals
23 Gets on better adults
24 Many fears/ scared
25 Sees tasks through
After coming clinic, child’s problem
Coming to clinic been helpful
Has difficulties in one or more areas
Upset or distress the child
Interfere home life
Interfere friendships
Interfere classroom learning
Interfere leisure activities
Burden
Prosocial
Hyperactivity
Emotional
Conduct
Peer
Total Difficulties
Internalizing
Externalizing

Client: Form: Referrer SDQ Form

No. Item
1 Considerate
2 Restless
3 Headaches
4 Shares – Other children
5 Temper
6 Solitary – Plays alone
7 Usually, obedient
8 Many worries
9 Helpful if someone hurt
10 Fidget/ Squirming
11 At least one good friend
12 Fights other children
13 Unhappy/ downhearted
14 Liked by other children
15 Distracted
16 Nervous/ Clingy
17 Kind younger children
18 Often lies or cheats
19 Picked on/ bullied
20 Volunteers help other
21 Thinks before acting
22 Steals
23 Gets on better adults
24 Many fears/ scared
25 Sees tasks through
After coming clinic, child’s problem
Coming to clinic been helpful
Has difficulties in one or more areas
Upset or distress the child
Interfere friendships
Interfere classroom learning
Burden
Prosocial
Hyperactivity
Emotional
Conduct
Peer
Total Difficulties
Internalizing
Externalizing
Qualitative Feedback

Date: