1 – Not At All
2 – A Little
3 – Some
4 – A Lot
¹
1
2
3
4
1
I was bothered by things that usually don't bother me.
2
I did not feel like eating, I wasn't very hungry.
3
I wasn't able to feel happy, even when my family or friends tried to help me feel better.
4
I felt like I was just as good as other kids.
5
I felt like I couldn't pay attention to what I was doing.
6
I felt down and unhappy.
7
I felt like I was too tired to do things.
8
I felt like something good was going to happen.
9
I felt like things I did before didn't work out right.
10
I felt scared.
11
I didn't sleep as well as I usually sleep
12
I was happy.
13
I was more quiet than usual.
14
I felt lonely, like I didn't have any friends.
15
I felt like kids I know were not friendly or that they didn't want to be with me.
16
I had a good time.
17
I felt like crying.
18
I felt sad.
19
I felt people didn't like me.
20
It was hard to get started doing things.
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.