Parent SDQ - Pre Survey

Not true

Somewhat true

Certainly true

Considerate of other people's feelings

Considerate of other people's feelings Not true

Considerate of other people's feelings Somewhat true

Considerate of other people's feelings Certainly true

Restless, overactive, cannot stay still for long

Restless, overactive, cannot stay still for long Not true

Restless, overactive, cannot stay still for long Somewhat true

Restless, overactive, cannot stay still for long Certainly true

Often complains of headaches, stomach-aches or sickness

Often complains of headaches, stomach-aches or sickness Not true

Often complains of headaches, stomach-aches or sickness Somewhat true

Often complains of headaches, stomach-aches or sickness Certainly true

Shares readily with other young people, for example CDs, games, food

Shares readily with other young people, for example CDs, games, food Not true

Shares readily with other young people, for example CDs, games, food Somewhat true

Shares readily with other young people, for example CDs, games, food Certainly true

Often loses temper

Often loses temper Not true

Often loses temper Somewhat true

Often loses temper Certainly true

Would rather be alone than with other young people

Would rather be alone than with other young people Not true

Would rather be alone than with other young people Somewhat true

Would rather be alone than with other young people Certainly true

Generally well behaved, usually does what adults request

Generally well behaved, usually does what adults request Not true

Generally well behaved, usually does what adults request Somewhat true

Generally well behaved, usually does what adults request Certainly true

Many worries or often seems worried

Many worries or often seems worried Not true

Many worries or often seems worried Somewhat true

Many worries or often seems worried Certainly true

Helpful if someone is hurt, upset or feeling ill

Helpful if someone is hurt, upset or feeling ill Not true

Helpful if someone is hurt, upset or feeling ill Somewhat true

Helpful if someone is hurt, upset or feeling ill Certainly true

Constantly fidgeting or squirming

Constantly fidgeting or squirming Not true

Constantly fidgeting or squirming Somewhat true

Constantly fidgeting or squirming Certainly true

Has at least one good friend

Has at least one good friend Not true

Has at least one good friend Somewhat true

Has at least one good friend Certainly true

Often fights with other young people or bullies them

Often fights with other young people or bullies them Not true

Often fights with other young people or bullies them Somewhat true

Often fights with other young people or bullies them Certainly true

Often unhappy, depressed or tearful

Often unhappy, depressed or tearful Not true

Often unhappy, depressed or tearful Somewhat true

Often unhappy, depressed or tearful Certainly true

Generally liked by other young people

Generally liked by other young people Not true

Generally liked by other young people Somewhat true

Generally liked by other young people Certainly true

Easily distracted, concentration wanders

Easily distracted, concentration wanders Not true

Easily distracted, concentration wanders Somewhat true

Easily distracted, concentration wanders Certainly true

Nervous in new situations, easily loses confidence

Nervous in new situations, easily loses confidence Not true

Nervous in new situations, easily loses confidence Somewhat true

Nervous in new situations, easily loses confidence Certainly true

Kind to younger children

Kind to younger children Not true

Kind to younger children Somewhat true

Kind to younger children Certainly true

Often lies or cheats

Often lies or cheats Not true

Often lies or cheats Somewhat true

Often lies or cheats Certainly true

Picked on or bullied by other young people

Picked on or bullied by other young people Not true

Picked on or bullied by other young people Somewhat true

Picked on or bullied by other young people Certainly true

Often volunteers to help others (parents, teachers, children)

Often volunteers to help others (parents, teachers, children) Not true

Often volunteers to help others (parents, teachers, children) Somewhat true

Often volunteers to help others (parents, teachers, children) Certainly true

Thinks things out before acting

Thinks things out before acting Not true

Thinks things out before acting Somewhat true

Thinks things out before acting Certainly true

Steals from home, school or elsewhere

Steals from home, school or elsewhere Not true

Steals from home, school or elsewhere Somewhat true

Steals from home, school or elsewhere Certainly true

Gets along better with adults than with other young people

Gets along better with adults than with other young people Not true

Gets along better with adults than with other young people Somewhat true

Gets along better with adults than with other young people Certainly true

Many fears, easily scared

Many fears, easily scared Not true

Many fears, easily scared Somewhat true

Many fears, easily scared Certainly true

Good attention span, sees chores or homework through to the end

Good attention span, sees chores or homework through to the end Not true

Good attention span, sees chores or homework through to the end Somewhat true

Good attention span, sees chores or homework through to the end Certainly true

Question Title

* 4. Since coming to the service, are your child's problems:

Much worse

A bit worse

About the same

A bit better

Much better

Much worse

A bit worse

About the same

A bit better

Much better

Question Title

* 5. Has coming to the service been helpful in other ways, e.g. providing information or making the problems more bearable?

Not at all

Only a little

Quite a lot

A great deal

Not at all

Only a little

Quite a lot

A great deal

Question Title

* 6. Over the last month, has your child had difficulties in one or more of the following areas: emotions, concentration,behaviour or being able to get on with other people?

Yes - Minor difficulties

Yes - Definite difficulties

Yes - Severe difficulties

Yes - Minor difficulties

Yes - Definite difficulties

Yes - Severe difficulties

Question Title

* 7. If you have answered "Yes", please answer the following questions about these difficulties:

	Not at all	Only a little	Quite a lot	A great deal
Do the difficulties upset or distress your child?	Do the difficulties upset or distress your child? Not at all	Do the difficulties upset or distress your child? Only a little	Do the difficulties upset or distress your child? Quite a lot	Do the difficulties upset or distress your child? A great deal
Do the difficulties interfere with your child's everyday home life?	Do the difficulties interfere with your child's everyday home life? Not at all	Do the difficulties interfere with your child's everyday home life? Only a little	Do the difficulties interfere with your child's everyday home life? Quite a lot	Do the difficulties interfere with your child's everyday home life? A great deal
Do the difficulties interfere with your child's everyday friendships?	Do the difficulties interfere with your child's everyday friendships? Not at all	Do the difficulties interfere with your child's everyday friendships? Only a little	Do the difficulties interfere with your child's everyday friendships? Quite a lot	Do the difficulties interfere with your child's everyday friendships? A great deal
Do the difficulties interfere with your child's everyday classroom learning?	Do the difficulties interfere with your child's everyday classroom learning? Not at all	Do the difficulties interfere with your child's everyday classroom learning? Only a little	Do the difficulties interfere with your child's everyday classroom learning? Quite a lot	Do the difficulties interfere with your child's everyday classroom learning? A great deal
Do the difficulties interfere with your child's everyday leisure activities?	Do the difficulties interfere with your child's everyday leisure activities? Not at all	Do the difficulties interfere with your child's everyday leisure activities? Only a little	Do the difficulties interfere with your child's everyday leisure activities? Quite a lot	Do the difficulties interfere with your child's everyday leisure activities? A great deal
Do the difficulties put a burden on you or the family as a whole?	Do the difficulties put a burden on you or the family as a whole? Not at all	Do the difficulties put a burden on you or the family as a whole? Only a little	Do the difficulties put a burden on you or the family as a whole? Quite a lot	Do the difficulties put a burden on you or the family as a whole? A great deal

Question Title

* 8. Relationship with Child

Mother

Father

other

Mother

Father

other

Other (please specify)

Parent SDQ - Pre

Strengths and Difficulties Questionnaire

Question Title

* 1. Your childs name and gender

Question Title

* 2. Answer this about your child.

Question Title

* 3. Do you have any other comments or concerns?

Question Title

* 4. Since coming to the service, are your child's problems:

Question Title

* 5. Has coming to the service been helpful in other ways, e.g. providing information or making the problems more bearable?

Question Title

* 6. Over the last month, has your child had difficulties in one or more of the following areas: emotions, concentration,behaviour or being able to get on with other people?

Question Title

* 7. If you have answered "Yes", please answer the following questions about these difficulties:

Question Title

* 8. Relationship with Child

Question Title

* 9. Name and Date