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Brief Assessment Checklist for Adolescents (ages 12 to 17)

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Here are some statements that describe young people’s behaviour and feelings. For each statement, please circle the number that best describes your child in the last 4 to 6 months.  circle 0 if the statement is not true for this young person in the last 4 to 6 months.  circle 1 if the statement is partly true for this young person in the last 4 to 6 months.  circle 2 if the statement is mostly true for this young person in the last 4 to 6 months

Q1. Constantly seeking excitement or ‘thrills’

Question Settings ▼ ▲
0 1 2
Not true Partly true Mostly true

Dropdown List used: Constantly seeking excitement or ‘thrills’

Q2. Craves affection (single choice)

Question Settings ▼ ▲

0 1 2

Dropdown List used: Craves affection

Q3. Feels victimized or misunderstood

Question Settings ▼ ▲
0 1 2
Not true Partly true Mostly true

Dropdown List used: Feels victimized or misunderstood

Q4. Gorges food

Question Settings ▼ ▲
0 1 2
Not true Partly true Mostly true

Dropdown List used: Gorges food

Q5. Hides feelings (single choice)

Question Settings ▼ ▲

0 1 2

Dropdown List used: Hides feelings

Q6. Impulsive (acts rashly, without thinking)

Question Settings ▼ ▲
0 1 2
Not true Partly true Mostly true

Dropdown List used: Impulsive (acts rashly, without thinking)

Q7. Lacks guilt or empathy (single choice)

Question Settings ▼ ▲

0 1 2

Dropdown List used: Lacks guilt or empathy

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