Amen Child/teen General Symptom Checklist (Page 3 of 4) in pdf

(_____) (_____) 52. intense fear of gaining weight or becoming fat even though underweight

(_____) (_____) 53. feelings of being fat, even though you're underweight

(_____) (_____) 54. recurrent episodes of eating large amounts of food

(_____) (_____) 55. a feeling of lack of control over eating behavior

(_____) (_____) 56. eliminates food, such as self induced vomiting, laxatives, strict dieting or

strenuous exercise

(_____) (_____) 57. persistent worry with body shape and weight

(_____) (_____) 58. involuntary physical movements or motor tics (such as eye blinking,

shoulder shrugging, head jerking or picking).

(_____) (_____) 59. involuntary vocal sounds or verbal tics (such as coughing, puffing,

blowing, whistling, swearing).

(_____) (_____) 60. repetitive, motor behavior (e.g., hand shaking or waving, body rocking,

head banging, mouthing of objects, self-biting, picking at skin)

(_____) (_____) 61. passage of feces or urine in inappropriate places (e.g., clothing or floor).

(_____) (_____) 62. bed wetting. If present, how often?____________

(_____) (_____) 63. failure to speak in social situations despite speaking in other situations

(_____) (_____) 64. delusional or bizarre thoughts (thoughts others would think are false)

(_____) (_____) 65. visual hallucination, seeing objects or images that are not really present

(_____) (_____) 66. hearing voices that are not really present

(_____) (_____) 67. odd behaviors: List: _______________________________________

(_____) (_____) 68. poor personal hygiene or grooming

(_____) (_____) 69. inappropriate mood for the situation (i.e., laughing at sad events)

(_____) (_____) 70. frequent feelings that someone or something is out to hurt you

(_____) (_____) 71. problems with social relationships before the age of 5

(_____) (_____) 72. multiple changes in caregivers before the age of 5

(_____) (_____) 73. steals

(_____) (_____) 74. bullies, threatens, or intimidates others

(_____) (_____) 75. initiates physical fights

(_____) (_____) 76. cruel to animals

(_____) (_____) 77. force others to do things they do not want to do

(_____) (_____) 78. sets fires

(_____) (_____) 79. destroys property

Amen Child/teen General Symptom Checklist Page 3