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Kindergarten SDQ Caregiver English Report (Ages 4-10)
                                          Please complete this form for your Kindergarten student.
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Email *
Student Name *
Student ID# *
Student Date of Birth *
MM
/
DD
/
YYYY
Gender *
School 
 *
Parent(s)/Guardian(s) Full Name (s)  *
Relationship to Child  *
Parent(s)/Guardian(s) email address and/or phone number  *
For each item, please mark the box for Not True, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not absolutely certain. Please give your answers on the basis of the child's behavior over the last six months or this school year. *
Not True
Somewhat True
Certainly True
1. Considerate of other people's feelings
2. Restless, overactive, cannot stay still for long
3. Often complains of headaches, stomach-aches or sickness
4. Shares readily with other youth, for example pencils, books, food
5. Often loses temper
6. Rather solitary , prefer to play alone
7. Generally well behaved, usually does what adults request
8. Many worries or often seems worried
9. Helpful if someone is hurt, upset or feeling ill
10. Constantly fidgeting or squirming
11. Has at least one good friend
12. Often fights with other youth or bullies them
13. Often unhappy, depressed or tearful
14. Generally liked by other youth
15. Easily distracted, concentration wanders
16. Nervous or clingy in new situations, easily loses confidence
17. Kind to younger children
18. lies or cheats
19. Picked on or bullied by other youth
20. Often offers to help others (parents, teachers, children)
21. Thinks things out before acting
22. Steals from home, school or elsewhere
23. Gets along better with adults than with other youth
24. Many fears, easily scared
25. Good attention span, sees work through to the end
Do you have any other comments or concerns?  If you have none, write none. *
Overall, do you think that your child has difficulties in any of the following areas:
emotions, concentration, behavior or being able to get on with other people?
Clear selection
If you have answered "Yes", please answer the following questions about these difficulties:
How long have these difficulties been present?
Clear selection
Do the difficulties upset or distress your child?
Not at all
Only a little
A medium amount
A great deal
Select one
Clear selection
Do the difficulties interfere with your child's everyday life in the following areas?
Not at all
Only a little
A medium amount
A great deal
1S. Home Life
2S. Friendships
3S. Classroom Learning
4S. Leisure Activities
Clear selection
Do the difficulties put a burden on you or the family as a whole? 
Not at all
Only a little
A medium amount
A great deal
Select one
Clear selection
Submit
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