Preschool Pediatric Symptom Checklist (PPSC) 20210423 Client Name* First Last Client Date of Birth* MM slash DD slash YYYY Today's Date* MM slash DD slash YYYY 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?* Not at all Somewhat Very much 2. Does your child seem sad or unhappy?* Not at all Somewhat Very much 3. Does your child get upset if things are not done a certain way?* Not at all Somewhat Very much 4. Does your child have a hard time with change?* Not at all Somewhat Very much 5. Does your child have trouble playing with other children?* Not at all Somewhat Very much 6. Does your child break things on purpose?* Not at all Somewhat Very much 7. Does your child fight with other children?* Not at all Somewhat Very much 8. Does your child have trouble paying attention?* Not at all Somewhat Very much 9. Does your child have a hard time calming down?* Not at all Somewhat Very Much 10. Does your child have trouble staying with one activity?* Not at all Somewhat Very Much 11. Is your child aggressive?* Not at all Somewhat Very Much 12. Is your child fidgety or unable to sit still?* Not at all Somewhat Very Much 13. Is your child angry?* Not at all Somewhat Very Much 14. Is it hard to take your child out in public?* Not at all Somewhat Very Much 15. Is it hard to comfort your child?* Not at all Somewhat Very Much 16. Is it hard to know what your child needs?* Not at all Somewhat Very Much 17. Is it hard to keep your child on a schedule or routine?* Not at all Somewhat Very Much 18. Is it hard to get your child to obey you?* Not at all Somewhat Very Much Please click SUBMIT when complete
