martel.as.uky.edu

1. I am too forgetful *

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2. I make good use of my opportunities *

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3. I argue a lot *

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4. I work up to my ability *

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5. I blame others for my problems *

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6. I use drugs (other than alcohol and nicotine) for nonmedical purposes *

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If you answered yes to number 6, please describe

7. I brag *

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2

8. I have trouble concentrating or paying attention for long *

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9. I can't get my mind off certain thoughts *

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If you said yes, please describe

10. I have trouble sitting still *

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11. I am too dependent on others *

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12. I feel lonely *

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13. I feel confused or in a fog *

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14. I cry a lot *

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15. I am pretty honest *

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16. I am mean to others *

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17. I daydream a lot *

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18. I deliberately try to hurt or kill myself *

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2

19. I try to get a lot of attention *

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2

20. I damage or destroy my things *

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2

21. I damage or destroy things belonging to others *

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22. I worry about my future *

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2

23. I break rules at work or elsewhere *

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2

24. I don't eat as well as I should *

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25. I don't get along well with others *

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26. I don't feel guilty after doing something I shouldn't *

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27. I am jealous of others *

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28. I get along badly with my family *

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29. I am afraid of certain animals, situations, or a places *

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If you answered 1 or 2 to question 29, please describe

30. My realtions with the opposite sex are poor *

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31. I am afraid I might think or do something bad *

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32. I feel that I have to be perfect *

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33. I feel that no one loves me *

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34. I feel that others are out to get me *

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35. I feel worthless or inferior *

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2

36. I accidentally get hurt a lot, accident- prone *

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37. I get in many fights *

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38. My relations with neighbors are poor *

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39. I hang around people who get in trouble *

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40. I hear sounds or voices that other people think aren't there *

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If you answered 1 or 2 to number 40, please describe.

41. I am impulsive or act without thinking *

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42. I would rather be alone than with others *

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43. I lie or cheat *

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44. I feel overwhelmed by my responsibilities *

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45. I am nervouse or tense *

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46. Parts of my body twitch or make nervous movements *

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If you answered 1 or 2 to number 46, please describe

47. I lack self- confidence *

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2

48. I am not liked by others *

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2

49. I can do certain things better than other people *

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2

50. I am too fearful or anxious *

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2

51. I feel dizzy or lightheaded *

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2

52. I feel too guilty *

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2

53. I have trouble planning for the future *

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2

54. I feel tired without good reason *

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2

55. My moods swing between elation and depression *

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57. I physically attack people *

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58. I pick my skin or other parts of my body *

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2

If you answered 1 or 2 to number 58, please describe

59. I fail to finish things I should do *

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2

60. There is very little that I enjoy *

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61. My work performance is poor *

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62. I am poorly coordinated or clumsy *

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63. I would rather be with older people than with people of my own age *

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64. I have trouble setting priorities *

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65. I refuse to talk *

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66. I repeat certain acts over and over *

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67. I have trouble making or keeping friends *

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2

68. I scream or yell a lot *

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2

69. I am secretive or keep things to myself *

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2

70. I see things that other people think aren't there *

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2

If you answered 1 or 2 to number 70, please describe

71. I am self- conscious or easily embarrassed *

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2

72. I worry about my family *

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2

73. I meet my responsibilities to my family *

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2

74. I show off or clown *

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2

75. I am too shy or timid *

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2

76. My behavior is irresponsible *

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2

77. I sleep more than most other people during day and/or night *

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2

If you answered 1 or 2 to number 77, please describe

78. I have trouble making decisions *

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2

79. I have a speech problem *

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2

If you answered 1 or 2 to number 79, please describe

80. I stand up for my rights *

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2

81. My behavior is very changeable *

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2

82. I steal *

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2

83. I am easily bored *

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2

84. I do things that other people think are strange *

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2

If you answered 1 or 2 to number 84, please describe

85. I have thoughts that other people would think are strange *

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2

If you answered 1 or 2 to number 85, please describe

86. I am stubborn, sullen, or irritable *

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2

87. My moods or feelings change suddenly *

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88. I enjoy being with people *

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89. I rush into things without considering the risks *

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90. I drink too much alcohol or get drunk *

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91. I think about killing myself *

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92. I do things that may cause me trouble with the law *

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If you answered 1 or 2 to number 92, please describe

93. I talk too much *

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94. I tease others a lot *

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95. I have a hot temper *

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96. I think about sex too much *

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97. I threaten to hurt people *

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98. I like to help others *

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2

99. I dislike staying in one place for very long *

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2

100. I have trouble sleeping *

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2

If you answered 1 or 2 to number 100, please describe

101. I stay away from my job even when I'm not sick or not on vacation *

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2

102. I don't have much energy *

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2

103. I am unhappy, sad, or depressed *

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2

104. I am louder than others *

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2

105. People think I am disorganized *

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2

106. I try to be fair to others *

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2

107. I feel that I can't succeed *

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2

108. I tend to lose things *

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2

109. I like to try new things *

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2

110. I wish I were of the opposite sex *

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111. I keep from getting involved with others *

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112. I worry a lot *

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2

113. I worry about my relations with the opposite sex *

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2

114. I fail to pay my debts or meet other financial responsibilities *

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115. I feel restless or fidgety *

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116. I get upset too easily *

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2

117. I have trouble managing money or credit cards *

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2

118. I am too impatient *

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119. I am not good at details *

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120. I drive too fast *

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2

121. I tend to be late for appointments *

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2

122. I have trouble keeping a job *

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2

123. I am a happy person *

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2

martel.as.uky.edu

Main menu

Screening Visit

Childhood Symptoms Scale: Other-report for Visit 1

Adult Self- Report for Ages 18-59

Current status Update Form

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martel.as.uky.edu

Main menu

User login

Screening Visit

Childhood Symptoms Scale: Other-report for Visit 1

Adult Self- Report for Ages 18-59

Current status Update Form

Pages