BEHAVIORS - indicate # times behaviors
engaged in per month
|
Age Began
|
# times per
month
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BEHAVIORS
|
Age Began
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# times per
month
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Difficulty concentrating
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Feels things intensely
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Easily distracted
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Overly self critical, uncalled-for guilt
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Acts before thinking
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Tells things that are not true
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Difficulty waiting their turn
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Has imaginary friends
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Talks excessively and interrupts others who are talking
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Nail biting
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Does not listen when spoken to
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wets ___ soils clothing Day__ Night__
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Does not finish things
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Persistent fear of being separated from care taker
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Difficulty organizing task & activities
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Expressed repetitive irrational fears
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Loses things necessary for tasks or activities
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Repetitive behaviors, i.e.hand washing, erasing,
lining things up
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Forgetful
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Tics or body movements
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Sensitive to thoughts & feelings of others
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Teased or picked on
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Fidgets with hands or feet
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Overly shy
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Makes careless mistakes
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Constipation/diahrea
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Runs and climbs excessively when inappropriate
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Overly friendly with strangers
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Easily Frustrated or annoyed
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Rapid change in moods
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School /daycare contacted you about child’s behavior
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Sensitive to tags in clothing
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Argues with adults and or talks back
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Covers ears when exposed to loud sounds
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Anger outburst/ loses temper/tantrums
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Does not like to be touched
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Refuses to do as asked
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Likes to be rubbed intensely
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Deliberately annoys people
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Bumps into things
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Blames others for his/her mistakes or misbehaviors
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Dislikes bright lights
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Spiteful or vindictive
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Chews or eats non nutritive items
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Bullies, threatens, or intimidates others
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Difficulty with eye contact (not in trouble)
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Physically aggressive
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Rituals
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Physically cruel to animals
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Difficulty starting & stopping activities
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Deliberately engaged in fire setting
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Repeats same phrase inappropriately
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Deliberately destroyed others’ property
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Sexual acting out
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Picky eater
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Sleeps too little
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Express sadness
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Nightmares
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Low energy
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Purposely injured self
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Stares into space - appears spaced out
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Loss interest in things
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Bored Easily
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Trouble keeping tract of time
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Sexual Knowledge above expected age level
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Sexual knowledge below expected age level
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