Student History A surprising number of what are considered children may exhibit some of the behaviors and “normal” characteristics in an attempt to create an image and are not indicative of any serious psychological problems. Any comment you may have on these would be beneficial in our work with your child. Please all that apply to your child. Accident Lack of remorse Alcohol use Lies Aggression towards others Manipulative Alienation from parent/s Manipulated easily by others Anxiety Mood swings Blacks out Overeats Bedwetting Obnoxious Blames others Obnoxious Bullies Panic Attacks Basically unhappy Poor concentration or attention span Binges and/or purges Poor hygiene Car theft Phobias Cutting on herself Physical violence Cruelty to pets or animals Quarrelsome Cries easily or often Rage attacks Complains a lot Starves herself Defiant Suicide threats Destroys property Suicide attempts Difficult to control School failure Dishonest Sexually acting out Dare Devil Behavior Sexual identity issues Depressed mood Seeks attention Denies mistakes Sneaky and/or deceptive Denies mistakes Shy or timid Does not like touched Strange thoughts Drug use disturbances Easily frightened Theft Threatens others Excitable Truancy Frustrated easily Threatens others Fire setting Truancy Gang involvement Temper tantrums Irritable Vandalism Impulsive Verbally abusive Intimidated by others Violence Internet addiction Withdrawn Isolates Weapons Lack of motivation
Student History A surprising number of what are considered “normal” children may exhibit some of the behaviors and characteristics in an attempt to create an image and are not indicative of any serious psychological problems. Any comment you may have on these would be beneficial in our work with your child. Please all that apply to your child. Accident Alcohol use Aggression towards others Alienation from parent/s Anxiety Blacks out Bedwetting Blames others Bullies Basically unhappy Binges and/or purges Car theft Cutting on herself Cruelty to pets or animals Cries easily or often Complains a lot Defiant Destroys property Difficult to control Dishonest Dare Devil Behavior Depressed mood Denies mistakes Denies mistakes Does not like touched Drug use Easily frightened Excitable Frustrated easily Fire setting Gang involvement Irritable Impulsive Intimidated by others Internet addiction Isolates Lack of motivation Lack of remorse Lies Manipulative Manipulated easily by others Mood swings Overeats Obnoxious Obnoxious Panic Attacks Poor concentration or attention span Poor hygiene Phobias Physical violence Quarrelsome Rage attacks Starves herself Suicide threats Suicide attempts School failure Sexually acting out Sexual identity issues Seeks attention Sneaky and/or deceptive Shy or timid Strange thoughts disturbances Theft Threatens others Truancy Threatens others Truancy Temper tantrums Vandalism Verbally abusive Violence Withdrawn Weapons
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