Ages 2-4: Strengths and Difficulties Questionnaire

Ages 2-4: Strengths and Difficulties Questionnaire

To be completed by a caregiver, teacher, or self/child
Client's Name [your child's name]

First NameLast Name
Date of birth

MonthDayYear
Date
Name of caregiver completing this form

First NameLast Name
Relationship of person to child
Today's date

MonthDayYear
Date
In what setting do you receive services? check all that apply:

Phoenix OfficeLaveen OfficeTucson OfficeCottonwood OfficeTelehealth/RemoteIn HomeIn SchoolIn FacilityOther
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 your child's behavior over the last six months.
1. Considerate of other people's feelings

Not TrueSomewhat TrueCertainly True
2. Restless, overactive, cannot stay still for long

Not TrueSomewhat TrueCertainly True
3. Often complains of headaches, stomach-aches or sickness

Not TrueSomewhat TrueCertainly True
4. Shares readily with other children, for example toys, treats, pencils

Not TrueSomewhat TrueCertainly True
5. Often loses temper

Not TrueSomewhat TrueCertainly True
6. Rather solitary, prefers to play alone

Not TrueSomewhat TrueCertainly True
7. Generally well behaved, usually does what adults request

Not TrueSomewhat TrueCertainly True
8. Many worries or often seems worried

Not TrueSomewhat TrueCertainly True
9. Helpful if someone is hurt, upset or feeling ill

Not TrueSomewhat TrueCertainly True
10. Constantly fidgeting or squirming

Not TrueSomewhat TrueCertainly True
11. Has at least one good friend

Not TrueSomewhat TrueCertainly True
12. Often fights with other children or bullies them

Not TrueSomewhat TrueCertainly True
13. Often unhappy, depressed or tearful

Not TrueSomewhat TrueCertainly True
14. Generally liked by other children

Not TrueSomewhat TrueCertainly True
15. Easily distracted, concentration wanders

Not TrueSomewhat TrueCertainly True
16. Nervous or clingy in new situations, easily loses confidence

Not TrueSomewhat TrueCertainly True
17. Kind to younger children

Not TrueSomewhat TrueCertainly True
18. Often argumentative with adults

Not TrueSomewhat TrueCertainly True
19. Picked on or bullied by other children

Not TrueSomewhat TrueCertainly True
20. Often offers to help others (parents, teachers, other children)

Not TrueSomewhat TrueCertainly True
21. Can stop and think things out before acting

Not TrueSomewhat TrueCertainly True
22. Can be spiteful to others

Not TrueSomewhat TrueCertainly True
23. Gets along better with adults than with other children

Not TrueSomewhat TrueCertainly True
24. Many fears, easily scared

Not TrueSomewhat TrueCertainly True
25. Good attention span, sees work through to the end

Not TrueSomewhat TrueCertainly True
Calculation
Emotional Symptoms Score:
Conduct Problems Score:
Hyperactivity Score:
Peer Problems Score:
Prosocial Behavior Score:
Score Totals

P = Parent

T = Teacher

S = Self/client
26. Do you have any other comments or concerns?
27. Overall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behavior or being able to get on with other people?

NoYes - minor difficultiesYes - definite difficultiesYes - severe difficulties
If you have answered "Yes" to question 27, please answer the following questions about these difficulties:
How long have these difficulties been present?

Less than a month1-5 months6-12 monthsOver a year
Do the difficulties upset or distress your child?

Not at allOnly a littleA medium amountA great deal

Do the difficulties interfere with your child's everyday life in the following areas?

	Not at all	Only a little	A medium amount	A great deal
Home life
Friendships
Learning
Leisure Activities

Do the difficulties put a burden on you or the family as a whole?

Not at allOnly a littleA medium amountA great deal
Reference

https://www.sdqinfo.org/py/sdqinfo/b3.py?language=Englishqz(USA)
Should be Empty:

Ages 2-4: Strengths and Difficulties Questionnaire

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 your child's behavior over the last six months.