Please complete this self-assessment if changes in your child’s mood are not directly caused by a general medical condition or any physiological effects of a substance.
Over the past two months or longer, how often have you noticed or been concerned about any of the following statements in your child?
|
Question
|
Almost Never
|
Sometimes
|
Often
|
Very Often
|
| 1: My child’s mood and energy levels shift from time to time; from having boundless energy and feeling excessively elated or optimistic at times, to feeling irritable, fatigued, excessively sad, empty or hopeless at other times |
|
|
|
|
| 2: My child seems significantly more self-confident, capable and carefree than usual |
|
|
|
|
| 3: My child is rested and full of energy even when he or she gets a lot less sleep that usual (e.g. 3 hours or less per day) |
|
|
|
|
| 4: At times my child is much more talkative or speaks a lot faster than usual, and may interrupt people while they are talking |
|
|
|
|
| 5: My child is unable to slow their mind down or thinks faster than what he or she can speak |
|
|
|
|
| 6: My child has difficulty focusing for prolonged periods or gets easily distracted by outside interference, influences or disruptions |
|
|
|
|
| 7: My child is much more motivated than usual, works a lot harder, gets many new ideas, or gets very involved with planning or participating in multiple activities, such as work, academics, social or sexual activities |
|
|
|
|
| 8: My child engages in reckless activities even though these activities may result in very bad consequences for him or her |
|
|
|
|
| 9: Close friends, relatives, teachers or I have noticed times when my child did not seem like themself or that my child did or said things that were unusual, excessive, risky or annoying |
|
|
|
|
| 10: The changes in my child’s mood is having a negative impact on certain aspects of their life, school or relationships |
|
|
|
|
| 11: My child has been hospitalised before because of the negative impact the changes in their mood has caused |
|
|
|
|
| 12: My child has had a significant loss of interest or pleasure in most things |
|
|
|
|
| 13: My child has had a reduced appetite or ate far more than usual, or had a significant weight gain or loss |
|
|
|
|
| 14: My child has trouble falling or staying asleep, or slept much more than usual |
|
|
|
|
| 15: My child’s movements, speach or mental function seem slow at times, or the opposite, my child feels agitated, irritable and restless |
|
|
|
|
| 16: My child feels worthless, guilty or negative about himself or herself |
|
|
|
|
| 17: My child battles to think, concentrate, make decisions or complete tasks |
|
|
|
|
| 18: My child has expressed that life is not worth living, or has planned or attempted suicide before |
|
|
|
|
