This scientifically researched worksheet is designed to assist parents in identify signs of mental health distress in their children. It includes a range of common and uncommon indicators based on scientific literature. Please answer each question honestly and to the best of your ability. This worksheet is not a diagnostic tool but can help determine if seeking professional mental healthcare intervention for your child is advisable.
Instructions:
– For each question, select the response that best describes your child’s behavior, emotions, or experiences.
– Be as accurate and objective as possible.
– At the end of the worksheet, tally up the scores to gain insight into your child’s mental health needs.
Questions:
1. How often does your child express feelings of sadness or hopelessness?
a) Never
b) Occasionally
c) Frequently
d) Almost always
2. Does your child have trouble sleeping, such as insomnia or frequent nightmares?
a) No, rarely
b) Sometimes
c) Often
d) Almost every night
3. Has your child experienced a sudden change in appetite or significant weight loss/gain?
a) No
b) Yes, but it’s mild
c) Yes, moderately
d) Yes, significantly
4. Does your child often complain of physical symptoms like headaches or stomachaches without any apparent medical cause?
a) Rarely or never
b) Sometimes
c) Often
d) Almost always
5. How frequently does your child exhibit excessive worrying or anxiety about everyday activities or events?
a) Rarely or never
b) Occasionally
c) Frequently
d) Constantly
6. Does your child frequently engage in self-harming behaviors (e.g., cutting, burning)?***
a) Never
b) Rarely
c) Sometimes
d) Often
7. Has your child expressed thoughts of self-harm or suicide?***
a) No, never
b) Rarely
c) Sometimes
d) Yes, often
8. Does your child have difficulty concentrating or staying focused for tasks appropriate for their age?
a) Rarely or never
b) Sometimes
c) Often
d) Almost always
9. How often does your child exhibit extreme mood swings or emotional outbursts?
a) Rarely or never
b) Occasionally
c) Frequently
d) Almost always
10. Is your child frequently irritable or easily frustrated?
a) Rarely or never
b) Occasionally
c) Often
d) Almost always
11. Has your child experienced a sudden decline in academic performance or interest in activities they once enjoyed?
a) No, not at all
b) Yes, but it’s mild
c) Yes, moderately
d) Yes, significantly
12. How often does your child exhibit obsessive or compulsive behaviors (e.g., repetitive rituals, intrusive thoughts)?
a) Rarely or never
b) Occasionally
c) Frequently
d) Constantly
13. Does your child have difficulty forming or maintaining friendships?
a) No, not at all
b) Yes, but it’s mild
c) Yes, moderately
d) Yes, significantly
14. Has your child experienced any traumatic events (e.g., abuse, natural disaster) that may impact their mental well-being?
a) No
b) Yes, but it’s been addressed
c) Yes, and it’s ongoing
d) Yes, and it’s unresolved
15. How often does your child exhibit disordered eating patterns or rituals (e.g., extreme pickiness, food hoarding)?
a) Rarely or never
b) Occasionally
c) Frequently
d) Almost always
16. Does your child have difficulty expressing their emotions or seem emotionally detached?
a) Rarely or never
b) Sometimes
c) Often
d) Almost always
17. How often does your child engage in risky behaviors (e.g., substance abuse, reckless driving)?***
a) Never
b) Rarely
c) Sometimes
d) Frequently
18. Has your child exhibited any symptoms of psychosis (e.g., hallucinations, delusions)?***
a) No
b) Not sure
c) Yes, but it’s mild
d) Yes, and it’s severe
19. Does your child frequently complain of feeling tired or fatigued, even after adequate rest?
a) Rarely or never
b) Sometimes
c) Often
d) Almost always
20. How often does your child withdraw from social interactions or isolate themselves from family and friends?
a) Rarely or never
b) Occasionally
c) Frequently
d) Almost always
21. Does your child exhibit intense and prolonged periods of anger or rage?
a) Rarely or never
b) Sometimes
c) Often
d) Almost always
22. How often does your child exhibit excessive perfectionism or fear of failure?
a) Rarely or never
b) Occasionally
c) Frequently
d) Almost always
23. Has your child experienced significant trauma or loss in their life recently (e.g., death of a loved one, divorce)?
a) No
b) Yes, but it’s been addressed
c) Yes, and it’s ongoing
d) Yes, and it’s unresolved
24. Does your child exhibit symptoms of ADHD (Attention Deficit Hyperactivity Disorder) such as impulsivity, hyperactivity, and inattention?
a) No
b) Not sure
c) Yes, but it’s mild
d) Yes, and it’s severe
25. How often does your child exhibit symptoms of selective mutism (refusal to speak in certain situations)?
a) Never
b) Rarely
c) Sometimes
d) Frequently
Scoring: *** If your child exhibits any evidence of behaviors marked with ***, he/she needs an urgent assessment by a certified professional mental healthcare provider.
For questions 1-25:
a) = 0 points
b) = 1 point
c) = 2 points
d) = 3 points
Total Score:
0-25 points: Your child’s mental health appears to be generally stable. However, it’s essential to continue monitoring his/her behavior and emotions over time.
26-50 points: Your child may be experiencing some difficulties that could benefit from professional assessment and support. Consider consulting with a mental health professional to address concerns and explore potential interventions.
51-75 points: It is likely that your child is experiencing significant challenges with his/her mental health. Seeking professional help is strongly recommended to properly assess and address your child’s needs.
76-100 points: Your child’s mental health issues seem to be quite pronounced and are likely impacting daily functioning and well-being. Immediate intervention from a qualified mental health professional is urgent and crucial.
Works Cited:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
National Institute of Mental Health. (n.d.). Child and Adolescent Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml
Centers for Disease Control and Prevention (CDC). (2022). Data and Statistics on ADHD. Retrieved from https://www.cdc.gov/ncbddd/adhd/data.html
National Institute of Mental Health (NIMH). (n.d.). Child and Adolescent Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml
Substance Abuse and Mental Health Services Administration (SAMHSA). (2022). Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2020NSDUHFFRPDFWHTML/2020NSDUHFFR090120.htm
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