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Children's Depression Checklist

The following checklist will help you assess and document your child's feelings and behavior.

This information will provide your physician or therapist with a fairly good picture of your child's emotional state. Instructions: Be as objective and thorough as possible. Use additional paper if you need more space to share your observations or give examples.

Signs of Possible Depression
(Check all that apply)

Description
(How long, how often, give examples)


FEELINGS. DOES YOUR CHILD EXPRESS THE FOLLOWING

 

• Sadness

 

• Emptiness

 

• Hopelessness

 

• Guilt

 

• Worthlessness

 

• Not enjoying everyday pleasures

 

 

 

THINKING. IS YOUR CHILD HAVING DIFFICULTY:

 

• Concentrating

 

• Making decisions

 

• Completing school work

 

• Maintaining grades

 

 

 

PHYSICAL PROBLEMS. DOES YOUR CHILD COMPLAIN OF:

 

• Headaches

 

• Stomachaches

 

• Joint or backaches

 

• Lack of energy

 

• Sleeping problems

 

• Weight or appetite changes (gain or loss)

 

 

 

BEHAVIORAL PROBLEMS. IS YOUR CHILD:

 

• Restless

 

• Irritable

 

• Not wanting to go to school

 

• Wanting to be alone most of the time

 

• Having difficulty getting along with others

 

• Cutting classes or skipping school

 

• Dropping out of sports, hobbies or activities

 

• Drinking or using drugs

 

 

 

SUICIDE RISK. DOES YOUR CHILD TALK OR THINK ABOUT:

 

• Suicide

 

• Death

 

• Other morbid subjects

 

Other Resources

Suicide Hotline
Phone: (800) 273-TALK (8255)
http://www.suicidepreventionlifeline.org/

Depression and Bipolar Support Alliance (DBSA)
800-826-3632
http://www.dbsalliance.org/

American Psychiatric Association
703-907-7300
www.psychiatry.org/

International Foundation for Research and Education on Depression
http://www.ifred.org/

National Institute of Mental Health
Phone Number: 301-443-4513
Toll Free Number: 1-866-615-6464
Fax Number: 301-443-4279
Email Address: nimhinfo@nih.gov
Website URL: www.nimh.nih.gov

500 Montgomery Street, Suite 820
 Alexandria, VA 22314

Phone (703) 684.7722

Toll Free (800) 969.6642

Fax (703) 684.5968

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