Directions: Each rating should be considered in the context of what is appropriate for the age of your child. Please think about your child’s behaviors since the last assessment scale was filled out when rating his/her behaviors
Scale: 0 = Never; 1 = Occasionally; 2 = Often; 3 = Very Often
Scale: 1 = Excellent; 2 = Above Average; 3 = Average; 4 = Somewhat of a Problem; 5 = Problematic
Has your child experienced any of the following side effects or problems in the past week? Are these side effects currently a problem?
FOR OFFICE USE ONLY
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