Strengths and Difficulties Questionnaire Parent Report Measure for Children aged 4-10 Baseline version (SDQ-PC1a)

Strengths and Difficulties Questionnaire
Parent Report Measure for
Children aged 4-10 Baseline version (SDQ-PC1a)

Please complete all information required in the form fields below

Strengths and Difficulties Questionnaire Parent Report Measure for Children aged 4-10 Baseline version (SDQ-PC1a)

Name *

Date of Birth *

Address
Address Line 1
City
State / Province / Region
Postal Code
This service is only available within South Australia. Check our services page for specific locations. Or contact Head to Health directly on 1800 595 212 or visit website www.headtohealth.gov.au for alternative services in their area.

For each item, please mark the box for Not true, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not absolutely certain. Please give our answers on the basis of your child’s behaviour over the last six months.

Kessler 10 Plus

Not True Somewhat True Certainly True

Considerate of other people's feelings
Not TrueConsiderate of other people's feelings Not True
Somewhat TrueConsiderate of other people's feelings Somewhat True
Certainly TrueConsiderate of other people's feelings Certainly True
Restless, overactive, cannot stay still for long
Not TrueRestless, overactive, cannot stay still for long Not True
Somewhat TrueRestless, overactive, cannot stay still for long Somewhat True
Certainly TrueRestless, overactive, cannot stay still for long Certainly True
Often complains of headaches, stomach-aches or sickness
Not TrueOften complains of headaches, stomach-aches or sickness Not True
Somewhat TrueOften complains of headaches, stomach-aches or sickness Somewhat True
Certainly TrueOften complains of headaches, stomach-aches or sickness Certainly True
Shares readily with other children, for example toys, treats, pencils
Not TrueShares readily with other children, for example toys, treats, pencils Not True
Somewhat TrueShares readily with other children, for example toys, treats, pencils Somewhat True
Certainly TrueShares readily with other children, for example toys, treats, pencils Certainly True
Often loses temper
Not TrueOften loses temper Not True
Somewhat TrueOften loses temper Somewhat True
Certainly TrueOften loses temper Certainly True
Rather solitary, prefers to play alone
Not TrueRather solitary, prefers to play alone Not True
Somewhat TrueRather solitary, prefers to play alone Somewhat True
Certainly TrueRather solitary, prefers to play alone Certainly True
Generally well behaved, usually does what adults request
Not TrueGenerally well behaved, usually does what adults request Not True
Somewhat TrueGenerally well behaved, usually does what adults request Somewhat True
Certainly TrueGenerally well behaved, usually does what adults request Certainly True
Many worries or often seems worried
Not TrueMany worries or often seems worried Not True
Somewhat TrueMany worries or often seems worried Somewhat True
Certainly TrueMany worries or often seems worried Certainly True
Helpful if someone is hurt, upset or feeling ill
Not TrueHelpful if someone is hurt, upset or feeling ill Not True
Somewhat TrueHelpful if someone is hurt, upset or feeling ill Somewhat True
Certainly TrueHelpful if someone is hurt, upset or feeling ill Certainly True
Constantly fidgeting or squirming
Not TrueConstantly fidgeting or squirming Not True
Somewhat TrueConstantly fidgeting or squirming Somewhat True
Certainly TrueConstantly fidgeting or squirming Certainly True
Has at least one good friend
Not TrueHas at least one good friend Not True
Somewhat TrueHas at least one good friend Somewhat True
Certainly TrueHas at least one good friend Certainly True
Often fights with other children or bullies them
Not TrueOften fights with other children or bullies them Not True
Somewhat TrueOften fights with other children or bullies them Somewhat True
Certainly TrueOften fights with other children or bullies them Certainly True
Often unhappy, depressed or tearful
Not TrueOften unhappy, depressed or tearful Not True
Somewhat TrueOften unhappy, depressed or tearful Somewhat True
Certainly TrueOften unhappy, depressed or tearful Certainly True
Generally liked by other children
Not TrueGenerally liked by other children Not True
Somewhat TrueGenerally liked by other children Somewhat True
Certainly TrueGenerally liked by other children Certainly True
Easily distracted, concentration wanders
Not TrueEasily distracted, concentration wanders Not True
Somewhat TrueEasily distracted, concentration wanders Somewhat True
Certainly TrueEasily distracted, concentration wanders Certainly True
Nervous or clingy in new situations, easily loses confidence
Not TrueNervous or clingy in new situations, easily loses confidence Not True
Somewhat TrueNervous or clingy in new situations, easily loses confidence Somewhat True
Certainly TrueNervous or clingy in new situations, easily loses confidence Certainly True
Kind to younger children
Not TrueKind to younger children Not True
Somewhat TrueKind to younger children Somewhat True
Certainly TrueKind to younger children Certainly True
Often lies or cheats
Not TrueOften lies or cheats Not True
Somewhat TrueOften lies or cheats Somewhat True
Certainly TrueOften lies or cheats Certainly True
Picked on or bullied by other children
Not TruePicked on or bullied by other children Not True
Somewhat TruePicked on or bullied by other children Somewhat True
Certainly TruePicked on or bullied by other children Certainly True
Often volunteers to help others (parents, teachers, other children)
Not TrueOften volunteers to help others (parents, teachers, other children) Not True
Somewhat TrueOften volunteers to help others (parents, teachers, other children) Somewhat True
Certainly TrueOften volunteers to help others (parents, teachers, other children) Certainly True
Thinks things out before acting
Not TrueThinks things out before acting Not True
Somewhat TrueThinks things out before acting Somewhat True
Certainly TrueThinks things out before acting Certainly True
Steals from home, school or elsewhere
Not TrueSteals from home, school or elsewhere Not True
Somewhat TrueSteals from home, school or elsewhere Somewhat True
Certainly TrueSteals from home, school or elsewhere Certainly True
Gets along better with adults than with other children
Not TrueGets along better with adults than with other children Not True
Somewhat TrueGets along better with adults than with other children Somewhat True
Certainly TrueGets along better with adults than with other children Certainly True
Many fears, easily scared
Not TrueMany fears, easily scared Not True
Somewhat TrueMany fears, easily scared Somewhat True
Certainly TrueMany fears, easily scared Certainly True
Good attention span, sees chores or homework through to the end
Not TrueGood attention span, sees chores or homework through to the end Not True
Somewhat TrueGood attention span, sees chores or homework through to the end Somewhat True
Certainly TrueGood attention span, sees chores or homework through to the end Certainly True

No Yes, minor difficulties Yes, definite difficulties Yes, severe difficulties

Overall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people?
NoOverall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? No
Yes, minor difficultiesOverall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? Yes, minor difficulties
Yes, definite difficultiesOverall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? Yes, definite difficulties
Yes, severe difficultiesOverall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? Yes, severe difficulties

	No	Yes, minor difficulties	Yes, definite difficulties	Yes, severe difficulties
Overall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people?	NoOverall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? No	Yes, minor difficultiesOverall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? Yes, minor difficulties	Yes, definite difficultiesOverall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? Yes, definite difficulties	Yes, severe difficultiesOverall, do you think that your child has difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people? Yes, severe difficulties

If you have answered "Yes", please answer the following questions about these difficulties:

Less than a month 1-5 months 6-12 months Over a year

How long have these difficulties been present?
Less than a monthHow long have these difficulties been present? Less than a month
1-5 monthsHow long have these difficulties been present? 1-5 months
6-12 monthsHow long have these difficulties been present? 6-12 months
Over a yearHow long have these difficulties been present? Over a year

	Less than a month	1-5 months	6-12 months	Over a year
How long have these difficulties been present?	Less than a monthHow long have these difficulties been present? Less than a month	1-5 monthsHow long have these difficulties been present? 1-5 months	6-12 monthsHow long have these difficulties been present? 6-12 months	Over a yearHow long have these difficulties been present? Over a year

Not at all Only a little Quite a lot A great deal

Do the difficulties upset or distress your child?
Not at allDo the difficulties upset or distress your child? Not at all
Only a littleDo the difficulties upset or distress your child? Only a little
Quite a lotDo the difficulties upset or distress your child? Quite a lot
A great dealDo the difficulties upset or distress your child? A great deal

	Not at all	Only a little	Quite a lot	A great deal
Do the difficulties upset or distress your child?	Not at allDo the difficulties upset or distress your child? Not at all	Only a littleDo the difficulties upset or distress your child? Only a little	Quite a lotDo the difficulties upset or distress your child? Quite a lot	A great dealDo the difficulties upset or distress your child? A great deal

Do the difficulties interfere with your child's everyday life in the following areas?

Not at all Only a little Quite a lot A great deal

Home Life
Not at allHome Life Not at all
Only a littleHome Life Only a little
Quite a lotHome Life Quite a lot
A great dealHome Life A great deal
Friendships
Not at allFriendships Not at all
Only a littleFriendships Only a little
Quite a lotFriendships Quite a lot
A great dealFriendships A great deal
Classroom Learning
Not at allClassroom Learning Not at all
Only a littleClassroom Learning Only a little
Quite a lotClassroom Learning Quite a lot
A great dealClassroom Learning A great deal
Leisure Activities
Not at allLeisure Activities Not at all
Only a littleLeisure Activities Only a little
Quite a lotLeisure Activities Quite a lot
A great dealLeisure Activities A great deal
Do the difficulties put a burden on you or the family as a whole?
Not at allDo the difficulties put a burden on you or the family as a whole? Not at all
Only a littleDo the difficulties put a burden on you or the family as a whole? Only a little
Quite a lotDo the difficulties put a burden on you or the family as a whole? Quite a lot
A great dealDo the difficulties put a burden on you or the family as a whole? A great deal

	Not at all	Only a little	Quite a lot	A great deal
Home Life	Not at allHome Life Not at all	Only a littleHome Life Only a little	Quite a lotHome Life Quite a lot	A great dealHome Life A great deal
Friendships	Not at allFriendships Not at all	Only a littleFriendships Only a little	Quite a lotFriendships Quite a lot	A great dealFriendships A great deal
Classroom Learning	Not at allClassroom Learning Not at all	Only a littleClassroom Learning Only a little	Quite a lotClassroom Learning Quite a lot	A great dealClassroom Learning A great deal
Leisure Activities	Not at allLeisure Activities Not at all	Only a littleLeisure Activities Only a little	Quite a lotLeisure Activities Quite a lot	A great dealLeisure Activities A great deal
Do the difficulties put a burden on you or the family as a whole?	Not at allDo the difficulties put a burden on you or the family as a whole? Not at all	Only a littleDo the difficulties put a burden on you or the family as a whole? Only a little	Quite a lotDo the difficulties put a burden on you or the family as a whole? Quite a lot	A great dealDo the difficulties put a burden on you or the family as a whole? A great deal

Over the last six months, have your child’s teachers complained of:

No A little A lot

Fidgetiness, restlessness or overactivity
NoFidgetiness, restlessness or overactivity No
A littleFidgetiness, restlessness or overactivity A little
A lotFidgetiness, restlessness or overactivity A lot
Poor concentration or being easily distracted
NoPoor concentration or being easily distracted No
A littlePoor concentration or being easily distracted A little
A lotPoor concentration or being easily distracted A lot
ting without thinking, frequently butting in, or not waiting for his or her turn
Noting without thinking, frequently butting in, or not waiting for his or her turn No
A littleting without thinking, frequently butting in, or not waiting for his or her turn A little
A lotting without thinking, frequently butting in, or not waiting for his or her turn A lot

	No	A little	A lot
Fidgetiness, restlessness or overactivity	NoFidgetiness, restlessness or overactivity No	A littleFidgetiness, restlessness or overactivity A little	A lotFidgetiness, restlessness or overactivity A lot
Poor concentration or being easily distracted	NoPoor concentration or being easily distracted No	A littlePoor concentration or being easily distracted A little	A lotPoor concentration or being easily distracted A lot
ting without thinking, frequently butting in, or not waiting for his or her turn	Noting without thinking, frequently butting in, or not waiting for his or her turn No	A littleting without thinking, frequently butting in, or not waiting for his or her turn A little	A lotting without thinking, frequently butting in, or not waiting for his or her turn A lot

Completed by;

Date

Name

	Not True	Somewhat True	Certainly True
Considerate of other people's feelings	Not TrueConsiderate of other people's feelings Not True	Somewhat TrueConsiderate of other people's feelings Somewhat True	Certainly TrueConsiderate of other people's feelings Certainly True
Restless, overactive, cannot stay still for long	Not TrueRestless, overactive, cannot stay still for long Not True	Somewhat TrueRestless, overactive, cannot stay still for long Somewhat True	Certainly TrueRestless, overactive, cannot stay still for long Certainly True
Often complains of headaches, stomach-aches or sickness	Not TrueOften complains of headaches, stomach-aches or sickness Not True	Somewhat TrueOften complains of headaches, stomach-aches or sickness Somewhat True	Certainly TrueOften complains of headaches, stomach-aches or sickness Certainly True
Shares readily with other children, for example toys, treats, pencils	Not TrueShares readily with other children, for example toys, treats, pencils Not True	Somewhat TrueShares readily with other children, for example toys, treats, pencils Somewhat True	Certainly TrueShares readily with other children, for example toys, treats, pencils Certainly True
Often loses temper	Not TrueOften loses temper Not True	Somewhat TrueOften loses temper Somewhat True	Certainly TrueOften loses temper Certainly True
Rather solitary, prefers to play alone	Not TrueRather solitary, prefers to play alone Not True	Somewhat TrueRather solitary, prefers to play alone Somewhat True	Certainly TrueRather solitary, prefers to play alone Certainly True
Generally well behaved, usually does what adults request	Not TrueGenerally well behaved, usually does what adults request Not True	Somewhat TrueGenerally well behaved, usually does what adults request Somewhat True	Certainly TrueGenerally well behaved, usually does what adults request Certainly True
Many worries or often seems worried	Not TrueMany worries or often seems worried Not True	Somewhat TrueMany worries or often seems worried Somewhat True	Certainly TrueMany worries or often seems worried Certainly True
Helpful if someone is hurt, upset or feeling ill	Not TrueHelpful if someone is hurt, upset or feeling ill Not True	Somewhat TrueHelpful if someone is hurt, upset or feeling ill Somewhat True	Certainly TrueHelpful if someone is hurt, upset or feeling ill Certainly True
Constantly fidgeting or squirming	Not TrueConstantly fidgeting or squirming Not True	Somewhat TrueConstantly fidgeting or squirming Somewhat True	Certainly TrueConstantly fidgeting or squirming Certainly True
Has at least one good friend	Not TrueHas at least one good friend Not True	Somewhat TrueHas at least one good friend Somewhat True	Certainly TrueHas at least one good friend Certainly True
Often fights with other children or bullies them	Not TrueOften fights with other children or bullies them Not True	Somewhat TrueOften fights with other children or bullies them Somewhat True	Certainly TrueOften fights with other children or bullies them Certainly True
Often unhappy, depressed or tearful	Not TrueOften unhappy, depressed or tearful Not True	Somewhat TrueOften unhappy, depressed or tearful Somewhat True	Certainly TrueOften unhappy, depressed or tearful Certainly True
Generally liked by other children	Not TrueGenerally liked by other children Not True	Somewhat TrueGenerally liked by other children Somewhat True	Certainly TrueGenerally liked by other children Certainly True
Easily distracted, concentration wanders	Not TrueEasily distracted, concentration wanders Not True	Somewhat TrueEasily distracted, concentration wanders Somewhat True	Certainly TrueEasily distracted, concentration wanders Certainly True
Nervous or clingy in new situations, easily loses confidence	Not TrueNervous or clingy in new situations, easily loses confidence Not True	Somewhat TrueNervous or clingy in new situations, easily loses confidence Somewhat True	Certainly TrueNervous or clingy in new situations, easily loses confidence Certainly True
Kind to younger children	Not TrueKind to younger children Not True	Somewhat TrueKind to younger children Somewhat True	Certainly TrueKind to younger children Certainly True
Often lies or cheats	Not TrueOften lies or cheats Not True	Somewhat TrueOften lies or cheats Somewhat True	Certainly TrueOften lies or cheats Certainly True
Picked on or bullied by other children	Not TruePicked on or bullied by other children Not True	Somewhat TruePicked on or bullied by other children Somewhat True	Certainly TruePicked on or bullied by other children Certainly True
Often volunteers to help others (parents, teachers, other children)	Not TrueOften volunteers to help others (parents, teachers, other children) Not True	Somewhat TrueOften volunteers to help others (parents, teachers, other children) Somewhat True	Certainly TrueOften volunteers to help others (parents, teachers, other children) Certainly True
Thinks things out before acting	Not TrueThinks things out before acting Not True	Somewhat TrueThinks things out before acting Somewhat True	Certainly TrueThinks things out before acting Certainly True
Steals from home, school or elsewhere	Not TrueSteals from home, school or elsewhere Not True	Somewhat TrueSteals from home, school or elsewhere Somewhat True	Certainly TrueSteals from home, school or elsewhere Certainly True
Gets along better with adults than with other children	Not TrueGets along better with adults than with other children Not True	Somewhat TrueGets along better with adults than with other children Somewhat True	Certainly TrueGets along better with adults than with other children Certainly True
Many fears, easily scared	Not TrueMany fears, easily scared Not True	Somewhat TrueMany fears, easily scared Somewhat True	Certainly TrueMany fears, easily scared Certainly True
Good attention span, sees chores or homework through to the end	Not TrueGood attention span, sees chores or homework through to the end Not True	Somewhat TrueGood attention span, sees chores or homework through to the end Somewhat True	Certainly TrueGood attention span, sees chores or homework through to the end Certainly True