List Of Children'S Behaviors Form

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LIST OF CHILDREN’S BEHAVIORS
Name: __________________________________________________
Age: ___________________ Today’s Date: ____________________
Please read the following list and rate your child on each behavior. Indicate how often your child displays that
behavior by circling which best describes the frequency of that behavior. Please use the provided scale.
Never
1
2
Rarely
Occasionally
3
4
Frequently
5
Very Frequently
Item
Scale
Item
Scale
Has trouble sleeping
1
2
3
4
5
Has poor appetite
1
2
3
4
5
Seems sad or unhappy
Talks about feeling stupid or worthless
1
2
3
4
5
1
2
3
4
5
Looses interest in having fun
1
2
3
4
5
Seems irritable
1
2
3
4
5
A
Moody
1
2
3
4
5
Plays alone
1
2
3
4
5
Cries easily
1
2
3
4
5
Seems tired
1
2
3
4
5
Complains of physical problems, like headaches or
Worries
1
2
3
4
5
1
2
3
4
5
stomach aches
Lacks confidence in his/her abilities
1
2
3
4
5
Needs lots of reassurance
1
2
3
4
5
Needs to be perfect
1
2
3
4
5
Seems fearful and anxious
1
2
3
4
5
B
Seems shy or timid
1
2
3
4
5
Easily embarrassed
1
2
3
4
5
Sensitive to criticism
Bite fingernails
1
2
3
4
5
1
2
3
4
5
Always on the go
1
2
3
4
5
Can’t sit still
1
2
3
4
5
Doesn’t seem to listen
1
2
3
4
5
Often fails to finish things
1
2
3
4
5
C
Has poor concentration and attention when it comes to
1
2
3
4
5
Often fidgets wi
th hands or feet, or
1
2
3
4
5
schoolwork
squirms in seat
Easily distracted
Has a hard time playing quietly
1
2
3
4
5
1
2
3
4
5

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00 votes

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