Form31 - [FORM 31-Use the top of this page for your...

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[ FORM 31 —Use the top of this page for your letterhead.] Child Checklist of Characteristics Name: Date: Age: Person completing this form: Many concerns can apply to both children and adults. If you have brought a child for evaluation or treatment, first please mark all of the items that apply to your child on the “Adult Checklist of Concerns.” Then review this checklist, which contains concerns (as well as positive traits) that apply mostly to children, and mark any items that describe your child. Feel free to add any others at the end under “Any other characteristics.” q Affectionate q Argues, “talks back,” smart-alecky, defiant q Bullies/intimidates, teases, inflicts pain on others, is bossy to others, picks on, provokes q Cheats q Cruel to animals q Concern for others q Conflicts with parents over persistent rule breaking, money, chores, homework, grades, choices in music/clothes/hair/friends q Complains q Cries easily, feelings are easily hurt q Dawdles, procrastinates, wastes time q
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Form31 - [FORM 31-Use the top of this page for your...

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