CHECKLIST OF CONCERNS
 Frequently steals | Is frequently angry or loses temper often |
| Frequently lies or is deceitful | Frequently argues with adults |
| Has run away from home | Is easily annoyed by others, highly irritable |
| Has deliberately set fires | Often blames others for his/her mistakes |
| Is truant from school | Often defies or ignores adult requests |
| Has broken into a car or dwelling | Refuses to follow directions or rules |
| Has deliberately destroyed another's property | Has a low frustration tolerance |
| Is physically cruel to others | Deliberately annoys or provokes others |
| Is physically cruel to animals | Avoids taking responsibility for behavior |
| Often initiates physical fights | Frequently swears or uses foul language |
| Has forced another into sexual activity | Is overly disrespectful to authority |
| Carries (or has carried) a weapon | Has no concern for consequences |
| Has used a weapon to hurt someone | Becomes destructive when angry |
| Has legal problems | Becomes aggressive/assaultive when angry |
| Has a history of drug, tobacco, or alcohol use | Is overly controlling of others |
| Appears to be influences by gangs | Has threatened to harm/kill others |
| Participates in gang activity | Doesn't get along well with others |
| Displays inappropriate/inconsistent emotions | Becomes vindictive when angry |
| Complains of "seeing things" (visual hallucinations) | Engages in self-harming or self-mutilation |
| Complains of "hearing voices" (auditory hallucinations) | Often attempts to manipulate others |
| Has bizarre thought processes | Often appears sad or depressed |
| Has homicidal thoughts/ideation | Withdraws or isolates from others |
| Has suicidal thoughts/ideation | Has feelings of worthlessness |
| Acts immaturely | Has a complete lack of motivation |
| Seeks negative attention | Often fidgets or squirms, can't sit still |
| Is overly preoccupied with sex | Is easily distracted |
| Acts out sexually | Has a difficult time following directions |
| Urinates or defecates in unusual places | Talks excessively at inappropriate times |
| Wets or soils self during the day | Has a difficult time following directions |
| Has problems at school | Often interrupts or intrudes on others |
| Has excessive anxiety and worry | Has a difficult time focusing on a task |
| Has a fear which disrupts daily life | Often acts impulsively (without thinking) |
| Often impedes on the rights of others | Has a difficult time playing quietly |
| Participates in dangerous/reckless behaviors | Often fails to complete chores or tasks |
OTHER: _____________________________________________________
OTHER: _____________________________________________________
If your child is receiving therapy, then this checklist may provide insight to the mental health professional that is caring for your child.