Adolescent Psychosocial Asessment (Page 9 of 14) in pdf

ADAPTABILITY (How easily does my child accept changes?)

Often fearful with new

Will easily meet and

people and new

____: ____: ____: ____: ____: ____: ____

accept new people and

situations

1 2 3 4 5 6 7

activities

ATTENTION SPAN/DISCTRACTIBILITY (How well does my child pay attention?)

Stays focused on tasks

Easily sidetracked;

until completed

____: ____: ____: ____: ____: ____: ____

difficulty following

1 2 3 4 5 6 7

directions

PARENT/CHILD RELATIONSHIP

Describe parenting your child (e.g. challenging, easy): _______________________________________________

What do you find most challenging in parenting your child? __________________________________________

What kind of discipline works best with your child? _________________________________________________

EDUCATION

Is your child currently enrolled in school?  Yes  No Name of School ______________________________

What grade is your child currently in (if summer, was grade is your child going into)? _____________________

How would you describe your child’s attendance (currently)? (circle ALL that apply)

Attending regularly

Home‐schooled Some truancy

Alternative school

Suspended

Expelled

Dropped Out GED program

How would you describe your child’s achievement/grades in school? __________________________________

How would you describe your child’s attitude towards school/education? ______________________________

Disciplinary or behavioral issues at school?  Yes  No If yes, describe: ____________________________

___________________________________________________________________________________________

Please check if your child has any of the following?

 Special Education Accommodations or a 504? Please describe: ____________________________________

 An Individualized Education Plan (IEP)?

Please describe: _____________________________________

 Diagnosed Learning Disability?

Please describe: _____________________________________

 Receiving special services at school?

Please describe: _____________________________________

Adolescent Psychosocial Asessment Page 9