#&BASC3 Cecil. Reynolds, PhD + RandyW. Kamphaus, PhD Your Name Date School Gender Male OFemale Age Instructions * This form contains sentences that tell how some boys and girls think cor feel or act. Read each sentence carefully. For the first group of sentences, you will have two answer choices: T or F. Select T for True if you agree with a sentence. Select F for False if you do not agree with a sentence. Heres an example: @r For the second group of sentences, you will have four answer choices: N,S,0, anda. Select N if the sentence never describes you or how you feel ul lke dogs. Select sif the sentence sometimes describes you or how you feel Select O ifthe sentence often describes you or how you feel. Select Af the sentence almost always describes you or how you fel Here is an example: 2. like doing homework NS @A PEARSO 67891011 12ABCDE Copyright © 2015 NCS Pearson, Inc. Al rights reserved. Portions of this work were previcusly published. Self-Report Child Ages 8-11 Birth Date I you wish to change an answer, markan X through it and circle your new choice, like this: ys @® Give the best answer for you for each sentence, even if itis hard to ‘make up your mind. There are no right or wrong answers Please do your best, tell the truth, and answer every sentence. Before starting, please fil in the information above these instructions. @PsychCorr Product Number 30818ea ree 1. [often do things without thinking, Tr 26, | wish were differet.. Tr 2, lke everyone meet. Tr 27. Loften worry about something bad happening tome... T F 3. Ifeel good about myself, Tr 28, Ihave attention problems. Te 4. My friends have more fun than | do. eF 28, | never break the rule... TF 5. I dont ke thinking about schoo! ee 4 30. Ihave no teeth. Tr 6. I never get into trouble. - TF 31. My parents blame too many oftheirproblemsonme... TF 7. have too many problems Tr 32 Ihave never been mean to anyone... Te 8. I never seem to get anything right... Te 33, | ke who lam, Tr 9. My teacher understands me.. Te 34. Sometimes I want to hurt myst. TF 10. My classmates don'like me Tr 35. have a hard time making frends... TF 11. I getmad at my parents sometimes... Tr 36, | always do what my parents tell me. TF 12. [think that | havea short attention span. Tr 37. never get my way. Tr 13. Sometimes, when alone, hear my name. Tr 38. | dont seem to do anything Tr 14. Nobody ever listens tome. TF 39. have some bad habits Tr 15, Itell the truth every single time. Tr 40, People tll me should pay more attention. Tr 16. | dont care about schoo! TFS 41. have never been ina cr. TF 17, Ihave never been to sleep. TF 42, Things go wrong for me, even when I try hard Tr 18. Other children don’t like to be with me. Tr ieel 19, lalways go to bed on time. Tr 20,_| cant seem to control what happens to me. TSE 21. | canit wait for schoo! to be over... TF 22. My parents are always ight... Tr 23, If havea problem, can usually work i out. Tr 24, | tell my parents everythin TF 25. Nothing ever goes right for me... TF nes 43, | get along well with others, 44, | amlett out of things 45, My parents are easy to talk to. 46. Even’ when alone, | fee! like someone is watching me. .. 47, My teacheris proud of me. 48, | getupset about my looks, 48, | get nervous 50, lke my parents ‘51, Ihave trouble sitting stil... 52. 1am bothered by teasing from others... 53, have trouble paying attention to the teacher... 54. When I take tests, can't think... 55. |feel lonely. 56, 57, 58. 59, 0, My parents are proud of mi o Cm 63. 64, 65. My parents trust me. Other kids hate to be with me. ama dependable fiend People say bad things to me | feel ike people are out to get me... feel sa. | want to do better, but | cant lam good at schoolwork NS Ns Ns Ns Ns Ns “NS NS Ns _NS feel stressed, ° ° ° ° ° ° ° ° ° ° Se eae: ae ll nee eeNea Sone 66. | feel that nobody likes me... 106, People tell me to be stil... 107. Imake mistakes... 108. Even when | ty hard, fal. 109. Other people seem to ignore me. 110. | get along with my teacher 67, ‘Vike my teacher.. 668, 1am disappointed with my grades.. 69. see things that others cannot see, 70. thate school. 71. People tele to slow down. 111. | get blamed for things I cant help... 112. feel out of place around people. 113. am a good listener... 114, | feel like | have no friends... 72. 1am someone you can count on.» 73. [forget to do things. 74, like going places with my parents... 75. {have trouble standing til in lines 115, | talk without waiting for others to say something 76. Little things bother me. 7. My school feels good to me. 78. tis hard for me to keep my mind on schoolwork... 116. hear voices in my head that no one else can hear. 117. {can solve dificult problems by myself. 118, 1am bothered by thoughts about death. 79, People think tm strange. 119. feel ike | want to quit schook.. 80, My teachertrusts me... 120. My parents listen to what | say... 1. feel depressed 82, My mother and father help me if| ask them to. 83. Iworry but | don't know why. 84, Ilike the way look 85. I get nervous when things do not go the right way for me. 121. Other people find things wrong with me. 122. 1 get into trouble for not paying attention, 123, Mylooks bother me... 124, fail at things. 125. Lam afraid ofa lot of things... 126. | drink 50 glasses of milk every day. 127. Other people make fun of me. 86. | talk while other people are talkin 87. People act as if they don't hear me... 88. | see weird things... 89. People tell me that | am too noisy. 90. People tell me to try harder. 128. am good at making decisions... 129. Noone understands me. zz2z222222222222\22222\22222 eecc00l7 0 CFC 0|0 02 OC CloC 00 Clo0000 oh hole eh eo el ee ee el eS le Se 29 2000\0000'0/00000\00000\00000 >>> Rr >> er al> >>> ere r>r>er eee 130. People get mad at me, even when | dont do anything zzzz22\22z222z2\2z222222222\2222222222\22222\/22222 cee a ven ens WS1O.A 91. I worry about what is going to happen... SOA — 131. School is boring -NSOA 92, | hear things that others cannot hear SOA 132, listen when people are talking to me. NSOA 93, lam dependable. SOA 133, Myparents expect 0 much rom me. NSOA 94, Il ke my lifes geting worse and worse... son 134, Teachersare unit. NSOA 95, Lamliked by others - SOA = 135, lam proud of my parents NSOA 96, {am blamed for things I dont do. SOA 136. I worry when goto bed at right... NSOA 97. My teacher gets mad at mefor no good reason SOA 137, Mymather and father like my friends. NSOA 98, fel safe at schoo SoA 98. lamlonel. SOA Please be sure you have marked ll items. 100, | get mad at others.. SOA 101. fmhappy with wh lam. SOA 102, | have trouble controling my thoughts. soa 103. {have trouble paying attention to what Lam doing... NSO A 104, |am ara I might do something bad son 105, My parents ike to be with me SOA