Mood & Feelings Questionnaire
This form is about how your child might have been feeling or acting recently.
For each question, please respond according to how s/he has been feeling or acting in the past two
weeks.   NOT TRUE = 0;  SOMETIMES = 1;  TRUE = 2
Sign in to Google to save your progress. Learn more
First name, last initial *
First name, last initial *
Person completing *
NOT TRUE = 0;  SOMETIMES = 1;  TRUE = 2
1. S/he felt miserable or unhappy. *
Not True
True
2. S/he didn’t enjoy anything at all. *
Not True
True
3. S/he was less hungry than usual. *
Not True
True
4. S/he ate more than usual. *
Not True
True
5. S/he felt so tired s/he just sat around and did nothing. *
Not True
True
6. S/he was moving and walking more slowly than usual. *
Not True
True
7. S/he was very restless. *
Not True
True
8. S/he felt s/he was no good anymore. *
Not True
True
9. S/he blamed him/herself for things that weren’t his/her fault. *
Not True
True
10. It was hard for him/her to make up his/her mind. *
Not True
True
NOT TRUE = 0;  SOMETIMES = 1;  TRUE = 2
11. S/he felt grumpy and cross with his/her parents. *
Not True
True
12. S/he felt like talking less than usual. *
Not True
True
13. S/he was talking more slowly than usual. *
Not True
True
14. S/he cried a lot. *
Not True
True
15. S/he thought there was nothing good for him/her in the future. *
Not True
True
16. S/he thought that life wasn’t worth living. *
Not True
True
17. S/he thought about death or dying. *
Not True
True
18. S/he thought his/her family would be better off without him/her. *
Not True
True
19. S/he thought about killing him/herself. *
Not True
True
20. S/he didn’t want to see his/her friends. *
Not True
True
NOT TRUE = 0;  SOMETIMES = 1;  TRUE = 2
21. S/he found it hard to think properly or concentrate. *
Not True
True
22. S/he thought bad things would happen to him/her. *
Not True
True
23. S/he hated him/herself. *
Not True
True
24. S/he felt s/he was a bad person. *
Not True
True
25. S/he thought s/he looked ugly. *
Not True
True
26. S/he worried about aches and pains. *
Not True
True
27. S/he felt lonely *
Not True
True
28. S/he thought nobody really loved him/her. *
Not True
True
29. S/he didn’t have any fun at school. *
Not True
True
30. S/he thought s/he could never be as good as other kids. *
Not True
True
NOT TRUE = 0;  SOMETIMES = 1;  TRUE = 2
31. S/he felt s/he did everything wrong. *
Not True
True
32. S/he didn’t sleep as well as s/he usually sleeps. *
Not True
True
33. S/he slept a lot more than usual. *
Not True
True
34. S/he wasn’t as happy as usual, even when s/he was praised or rewarded. *
Not True
True
References:
Author: Adrian Angold

Angold, A., Costello, E. J., Messer, S. C., Pickles, A., Winder, F., & Silver, D. (1995) The development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237 - 249.  

Messer, S. C., Angold, A., Costello, E.J., Loeber, R., Van Kammen, W., & Stouthamer-Loeber, M. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: Factor composition and structure across development. International Journal of Methods in Psychiatric Research, 5, 251-262.

Article available in PDF format, with permission from Whurr Publishers Ltd. Download article
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Arkansas Families First, LLC. Report Abuse