SYMPTOM CHECK-LIST

SYMPTOM CHECK-LIST

PHYSICAL COMPLAINTS

Giddiness          

Abdominal Pain              

Headache           

Fits              

Others………...

BEHAVIOR PROBLEMS

Nervous               

Timid¹                   

Fidgety²                

Clumsy³                 

Aggressive

Overactive            

Stubborn             

Demanding                

Disobedient            

Bullying⁴ others

Getting bullied     

Anti-social         

Loitering⁵                 

Seclusive⁶              

Inattentive

Distractible⁷         

Impulsive¹⁰           

Motor retardation¹¹            

Temper tantrums¹²

SLEEP DISTURBANCES

Initial insomnia    

Terminal insomnia     

Total insomnia     

Afraid to go to sleep                   

Disturbed sleep     

Excessive reported sleep        

Nightmares & night terrors            

Somnambulism¹³

APPETITE

Normal                

Food fads¹⁴                    

Pica                

Others……….

PROBLEMS OF ELIMINATION

Constipation           

Diarrhea               

Enuresis                     

Dribbling¹⁵              

Encopresis

SCHOOLING

Irregular to school               

Scholastic backwardness                

Below average intelligence

Truancy –home/school             

Abnormal peer/ group adjustment         

Fear of going to school

READING DIFFICULTIES

In own language                       

In foreign language                     

Spelling mistakes

SPEECH & LANGUAGE DIFFICULTIES

Stammering¹⁶         

Lisping¹⁷               

Lalling           

Mutism             

Under talkative

Pronominal reversal               

Echolalia                           

Immature grammatical structure              

Personalized language                         

Inability to comprehend¹⁸ spoken language

SEXUAL PRACTICES

Masturbation          

Homosexuality                    

Transvestism                      

Others……….

SITUATION SPECIFIC ANXIETY

Being in a group                      

Being left alone                  

Vehicles                  

Animals

Undressing crowds                 

New people                              

Others……….

NEUROTIC SYMPTOMS

Tics          

Mannerisms              

Thumb sucking             

Nail biting              

Hypochondria¹⁹

Cruelty to animals   

Hysterical²⁰ symptoms (fits, possession, fugue, amnesia, unconsciousness, motor symptoms, sensory symptoms, visceral symptoms)             

Obsessions and compulsions

PSYCHOTIC SYMPTOMS

Hallucinations         

Delusions        

Autism       

Silly smile         

Neglect of personal hygiene

Speech block              

Withdrawal          

Increased Socialization           

Bizarre movements        

Inability to form relationships      

Preference to inanimate objects            

Irrelevant talk    

MOOD

Elated                 

Depressed              

Miserable                    

Irritable                   

Worrying           

Anxious                

Panicky                    

Fearful                         

Hostile                 

Suspicious

SUICIDAL RUMINATIONS AND ATTEMPTS

Ideation                     

Threats                       

Attempts

OTHERS…………………………………………………………………............

...........…………………………………………………………………………………………………

1.       Timid: Lacking courage or confidence.

2.      Fidgety: Make small movements through nervousness/impatience.

3.      Clumsy: Awkward (hard to do/deal with), (inconvenient) in movement or performance.

4.      Bully: A person who intimidates (frighten, esp. into doing something) weaker people.

5.      Loiter: Stand around idly (avoiding work; lazy; spend time wandering, doing nothing).

6.      Seclusion: Privacy.

7.      Distraction: Mental agitation

8.      Distraught: Very worried and upset.

9.      Distress: extreme anxiety, pain or hardship.

10.   Impulse: a sudden urge to do something/ a driving force.

11.    Retardation: holding back the development or progress of.

12.   Tantrum: an uncontrolled outburst of anger and frustration.

13.   Somnambulism: sleep walking.

14.   Fads: Craze

15.   Dribble : fall slowly in drops or a thin stream

16.   Stammer: speak with involuntary pauses and repetitions of the first letters of words.

17.   Lisp: a speech defect in which‘s’ and ‘z’ are pronounced like ‘th’.

18.   Comprehend: understand.

19.   Hypochondria: Constant and excessive anxiety about one’s health.

20.  Hysterical: extreme/uncontrollable emotion/excitement.

21.   Spasm: a sudden involuntary contraction of a muscle. A sudden spell of an activity/sensation.