| Childhood Depression Checklist
The following checklist will help you assess and document your child's feelings and behavior. This information will provide your physician or therapist with a fairly good picture of your child's emotional state.
Instructions: Be as objective and thorough as possible. Use additional paper if you need more space to share your observations or give examples.
| SIGNS OF POSSIBLE DEPRESSION (Check all that apply.) |
DESCRIPTION (How long, how often, give examples) |
| Feelings. Does your child express the following: |
- Sadness
- Emptiness
- Hopelessness
- Guilt
- Worthlessness
- Not enjoying everyday pleasures
|
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| Thinking. Is your child having difficulty: |
- Concentrating
- Making decisions
- Completing school work
- Maintaining grades
|
|
| Physical Problems. Does your child complain of: |
- Headaches
- Stomachaches
- Joint or backaches
- Lack of energy
- Sleeping problems
- Weight or appetite changes (gain or loss)
|
|
| Behavioral Problems. Is your child: |
- Restless
- Irritable
- Not wanting to go to school
- Wanting to be alone most of the time
- Having difficulty getting along with others
- Cutting classes or skipping school
- Dropping out of sports, hobbies or activities
- Drinking or using drugs
|
|
| Suicide Risk. Does your child talk or think about: |
- Suicide
- Death
- Other morbid subjects
|
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Source: Dubuque, S.E. A Parent's Survival Guide to Childhood Depression. King of Prussia, PA: The Center for Applied Psychology, Inc., 1996.
For more information about Childhood Depression Awareness Day, contact:
National Mental Health Association
(800) 969-NMHA (6642)
www.nmha.org
http://pbskids.org/itsmylife
Copyright © 2005 CastleWorks, Inc. All rights reserved.
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