Parent Screening Tool

The Pediatric Symptom Checklist is a questionnaire that helps identify and assess changes in emotional and behavioral problems in children.  Because parents are often the first to notice a concern with their child’s emotions, behavior, or learning, this tool may help give you an understanding of the level of concern. Please note that this screener is not meant to provide or rule out a diagnosis.  Only a trained professional can diagnose child mental health problems. 

Please select the answer that best fits your child under each heading.

 25%

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1. Complains of aches/pains
2. Spends more time alone
3. Tires easily, has little energy
4. Fidgety, unable to sit still
5. Has trouble with a teacher
6. Less interested in school
7. Acts as if driven by a motor
8. Daydreams too much
9. Distracted easily
10. Is afraid of new situations

 

ⓒ 1988, M.S. Jellinek and J.M .Murphy, Massachusetts General Hospital