Directions: Each rating should be considered in the context of what is appropriate for the age of the child you are rating and should reflect that child’s behavior since the last assessment scale was filled out.
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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