INSTRUCTIONS: The following is a list of children's behavior that may be assessed for mental health or behavioral concerns.

This questionnaire is not intended to replace a visit to a mental health professional or your child's pediatrician. Only a professional can diagnose a physical, neurological, mental or behavioral health concern.

The completed questionnaire can be shown to a health care professional to help open a dialogue about your concerns.

(c) 1988. M. S. Jellinek and J. M. Murphy, Massachusetts General Hospital

Question Title

* 1. I Agree