Ages 4 - 10: Strengths and Difficulties Questionnaire

Ages 4 - 10: 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:
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
2. Restless, overactive, cannot stay still for long
3. Often complains of headaches, stomach-aches or sickness
4. Shares readily with other children, for example toys, treats, pencils
5. Often loses temper
6. Rather solitary, prefers to play alone
7. Generally well behaved, usually does what adults request
8. Many worries or often seems worried
9. Helpful if someone is hurt, upset or feeling ill
10. Constantly fidgeting or squirming
11. Has at least one good friend
12. Often fights with other children or bullies them
13. Often unhappy, depressed or tearful
14. Generally liked by other children
15. Easily distracted, concentration wanders
16. Nervous or clingy in new situations, easily loses confidence
17. Kind to younger children
18. Often lies or cheats
19. Picked on or bullied by other children
20. Often offers to help others (parents, teachers, other children)
21. Thinks things out before acting
22. Steals from home, school or elsewhere
23. Gets along better with adults than with other children
24. Many fears, easily scared
25. Good attention span, sees chores or homework through to the end
Total Difficulties Score
Emotional Problem 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?
If you have answered "Yes" to question 27, please answer the following questions about these difficulties:
How long have these difficulties been present?
Do the difficulties upset or distress your child?

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

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

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

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

Ages 4 - 10: 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.