preschool pediatric symptom checklist (PPSC)

Client Name*

First Last

Client Date of Birth*

Today's Date*

These questions are about your child's behavior. Think about what you would expect of other children the same age, and tell us how much each statement applies to your child.

1. Does your child seem nervous or afraid?*

2. Does your child seem sad or unhappy?*

3. Does your child get upset if things are not done a certain way?*

4. Does your child have a hard time with change?*

5. Does your child have trouble playing with other children?*

6. Does your child break things on purpose?*

7. Does your child fight with other children?*

8. Does your child have trouble paying attention?*

9. Does your child have a hard time calming down?*

10. Does your child have trouble staying with one activity?*

11. Is your child aggressive?*

12. Is your child fidgety or unable to sit still?*

13. Is your child angry?*

14. Is it hard to take your child out in public?*

15. Is it hard to comfort your child?*

16. Is it hard to know what your child needs?*

17. Is it hard to keep your child on a schedule or routine?*

18. Is it hard to get your child to obey you?*