Parent Test: Your Child’s Mental Health

Test Questions

Optional Questions

Your Results

Pediatric Symptom Checklist

The questionnaire that follows can be used to see if your child is having emotional, attentional, or behavioral difficulties. For each item please mark how often your child:

Please note, all fields are required.

1. Feels sad, unhappy

2. Feels hopeless

3. Is down on self

4. Worries a lot

5. Seems to be having less fun

6. Fidgety, unable to sit still

7. Daydreams too much

8. Distracted easily

9. Has trouble concentrating

10. Acts as if driven by a motor

11. Fights with other children

12. Does not listen to rules

13. Does not understand other people’s feelings

14. Teases others

15. Blames others for his/her troubles

16. Refuses to share

17. Takes things that do not belong to him/her

Optional Questions

Please take a moment to answer the following optional questions. Your answers are totally anonymous—we won't be able to identify you based on this information. Your answers help us provide better information and support for people like you.

You can answer as many or as few questions as you would like. When you are done, scroll to the bottom of the survey and click "submit" to receive your screening results.

About Your Child

Child's Age

Child's Gender

Please check this box if your child identifies as transgender.

Child's Race/Ethnicity

Household Income

Does your child live in the United States or another country?

Zip/Postal Code

Which of the following populations describes your child? (Select all that apply)

Child of veteran or active-duty military Caregiver of someone living with emotional or physical illness LGBTQ+ Student Trauma survivor New or expecting parent Healthcare worker

About Your Child's Mental Health

Has your child ever received treatment/support for a mental health problem?

Think about your child's mental health test. What are the main things contributing to your child's mental health problems right now? (Choose up to 3)

About Your Child's Health

Is your child currently covered by health insurance?

Does your child have any of the following physical health conditions?

Comments

This field is for validation purposes and should be left unchanged.

Source

Pediatric Symptom Checklist – Parent Report

Jellinek, Murphy, et al. (1988). Pediatric Symptom Checklist: Screening school-age children for psychosocial dysfunction. The Journal of Pediatrics, 112(2), pp. 201-209. Retrieved from https://doi.org/10.1016/S0022-3476(88)80056-8

For more information, visit the Pediatric Symptom Checklist page at Massachusetts General Hospital Psychiatry: https://www.massgeneral.org/psychiatry/treatments-and-services/pediatric-symptom-checklist

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with a physician or healthcare provider. Mental Health America Inc., sponsors, partners, and advertisers disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, of the use and application of these screens.