Depression Assessment (Children)
Check the option that best describes how your child has been feeling. ow often has your child been bothered by each of the following symptoms during the past two weeks
Email *
First and Last Name  *
Please provide a phone number to call with your results.
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Feeling down, depressed, irritable, or hopeless? *
Required
Little interest or pleasure in doing things? *
Required
Trouble falling asleep, staying asleep, or sleeping too much? *
Required

Poor appetite, weight loss, or overeating? *
Required

Feeling tired, or having little energy? *
Required
Feeling bad about yourself- or feeling that you are a failure, or that you have let yourself or your family down?
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Required
Trouble concentrating on things like school, work, reading, or watching TV?
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Required
Moving or speaking so slowly that other people have noticed?
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Required
Being so fidgety or restless that you were moving around a lot more than usual?
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Required
Thought you would be better off dead, or of hurting yourself in some way?
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Required
If your child is experiencing any of the problems above, how difficult have these problems made it for them to do their homework, work, take care of things around the house, or get along with other people?
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Required
In the past year, has your child felt depressed or sad most day, even if they felt okay sometimes?
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Required
Have they EVER (in their whole life), tried to kill themselves or made a suicide attempt?
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Required
Has there been a time in the past month when your child has had serious thoughts about ending their life?
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Required
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