Pediatric Symptom Checklist - Youth Report (Y-PSC)

Patient Name:

Date:

Please select the option that best fits you:

1. Complain of aches or pains.

Never Sometimes Often

2. Spend more time alone

Never Sometimes Often

3. Tire easily, little energy

Never Sometimes Often

4. Fidgety, unable to sit still

Never Sometimes Often

5. Have trouble with teacher

Never Sometimes Often

6. Less interested in school

Never Sometimes Often

7. Act as if driven by motor

Never Sometimes Often

8. Daydream too much.

Never Sometimes Often

9. Distract easily

Never Sometimes Often

10. Are afraid of new situations

Never Sometimes Often

11. Feel sad, unhappy

Never Sometimes Often

12. Are irritable, angry

Never Sometimes Often

13. Feel hopeless.

Never Sometimes Often

14. Have trouble concentrating

Never Sometimes Often

15. Less interested in friends

Never Sometimes Often

16. Fight with other children

Never Sometimes Often

17. Absent from school

Never Sometimes Often

18. School grades dropping

Never Sometimes Often

19. Down on yourself

Never Sometimes Often

20. Visit doctor with doctor finding nothing wrong

Never Sometimes Often

21. Have trouble sleeping

Never Sometimes Often

22. Worry a lot

Never Sometimes Often

23. Want to be with parent more than before

Never Sometimes Often

24. Feel that you are bad

Never Sometimes Often

25. Take unnecessary risks

Never Sometimes Often

26. Get hurt frequently

Never Sometimes Often

27. Seem to be having less fun

Never Sometimes Often

28. Act younger than children your age

Never Sometimes Often

29. Do not listen to rules

Never Sometimes Often

30. Do not show feelings

Never Sometimes Often

31. Do not understand other people's feelings

Never Sometimes Often

32. Tease others

Never Sometimes Often

33. Blame others for your troubles

Never Sometimes Often

34. Take things that do not belong to you

Never Sometimes Often

35. Refuse to share

Never Sometimes Often

Total Score:

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