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1. |
Is your teenager acting depressed or more moody than usual (doesn't want to do anything, lost interest in favorite activities or hobbies, decreased attention, ineffective)? |
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2. |
Is your teen more forgetful than usual? |
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3. |
Does your teen overreact to small problems or criticism? |
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4. |
Does your teen have trouble thinking clearly? |
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5. |
Is your teen 'keyed up' at times (unable to relax, overly anxious, restless, high-pitched voice, nervous laughter)? |
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6. |
Does your teen suffer from insomnia or nightmares? |
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7. |
Is your teenager eating too little or too much? |
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8. |
Does your teen complain of pain in the neck, shoulders, or back, or does he/she get tension or migraine headaches? |
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9. |
Does your teen have stomach problems (cramps, heartburn, gas, constipation, diarrhea)? |
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10. |
Does your teen get dizzy or have a dry throat or mouth? |
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11. |
Does your teen ever have shortness of breath, irregular heart beat or heart palpitations, chest pain, or high blood pressure? |
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12. |
Has your teen lost hair? |
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13. |
Does your teen seem more 'out of control' than normal (impulsive behavior, emotional instability)? |
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14. |
Have you noticed an increase in risky behaviors by your teen (smoking, drinking alcohol, drugs, sexual behavior)? |
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15. |
FEMALES: Is your teenage daughter missing menstrual periods or have there been changes in her menstrual cycle? |
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Total 'Yes' |
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(out of 15 possible) |
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Interpretation |
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