Connors Parent Questionnaire

This form is a comprehensive behavioral and emotional assessment for children, completed by a parent or guardian. It includes a series of questions aimed at identifying a range of behaviors, emotional states, and social skills that may indicate developmental or psychological issues. The assessment covers topics such as attention, impulsivity, aggression, social interactions, anxiety, depression, and school performance. Parents rate the frequency or severity of each behavior or symptom based on their observations. The results help provide a detailed profile of the child’s behaviors and emotions, assisting healthcare professionals in identifying potential concerns and planning appropriate interventions or treatments.

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Name of Child

Date of Birth

Name of Parent Completing Form

Please answer all questions. Beside each item below, indicate the degree of the problem by a check mark.

1. Picks at things (nails, fingers, hair, clothing).

Not at all.
Just a little.
Pretty much.
Very much.

2. Sassy to grown-ups.

Not at all.
Just a little.
Pretty much.
Very much.

3. Problems with making or keeping friends.

Not at all.
Just a little.
Pretty much.
Very much.

4. Excitable, impulsive.

Not at all.
Just a little.
Pretty much.
Very much.

5. Wants to run things.

Not at all.
Just a little.
Pretty much.
Very much.

6. Sucks or chews (thumb, clothing, blankets).

Not at all.
Just a little.
Pretty much.
Very much.

7. Cries easily or often.

Not at all.
Just a little.
Pretty much.
Very much.

8. Carries a chip on his shoulder.

Not at all.
Just a little.
Pretty much.
Very much.

9. Daydreams.

Not at all.
Just a little.
Pretty much.
Very much.

10. Difficulty in learning.

Not at all.
Just a little.
Pretty much.
Very much.

11. Restless in the “squirmy” sense.

Not at all.
Just a little.
Pretty much.
Very much.

12. Fearful (of new situations, new people or places, school).

Not at all.
Just a little.
Pretty much.
Very much.

13. Restless, always up and on the go.

Not at all.
Just a little.
Pretty much.
Very much.

14. Destructive.

Not at all.
Just a little.
Pretty much.
Very much.

15. Tells lies or stories that are not true.

Not at all.
Just a little.
Pretty much.
Very much.

16. Shy.

Not at all.
Just a little.
Pretty much.
Very much.

17. Gets into more trouble than others of the same age.

Not at all.
Just a little.
Pretty much.
Very much.

18. Speaks differently from others of the same age (baby talk, stuttering, hard to understand).

Not at all.
Just a little.
Pretty much.
Very much.

19. Denies mistakes, or blames others.

Not at all.
Just a little.
Pretty much.
Very much.

20. Quarrelsome.

Not at all.
Just a little.
Pretty much.
Very much.

21. Puts and sulks.

Not at all.
Just a little.
Pretty much.
Very much.

22. Steals.

Not at all.
Just a little.
Pretty much.
Very much.

23. Disobedient or obeys but resentfully.

Not at all.
Just a little.
Pretty much.
Very much.

24. Worries more than others (about being alone; illness or death).

Not at all.
Just a little.
Pretty much.
Very much.

25. Fails to finish things.

Not at all.
Just a little.
Pretty much.
Very much.

26. Feelings easily hurt

Not at all.
Just a little.
Pretty much.
Very much.

27. Bullies others.

Not at all.
Just a little.
Pretty much.
Very much.

28. Unable to stop a repetitive activity.

Not at all.
Just a little.
Pretty much.
Very much.

29. Cruel.

Not at all.
Just a little.
Pretty much.
Very much.

30. Childish or immature (wants help he shouldn’t need, clings, needs constant reassurance).

Not at all.
Just a little.
Pretty much.
Very much.

31. Distractibility or attention span a problem.

Not at all.
Just a little.
Pretty much.
Very much.

32. Headaches

Not at all.
Just a little.
Pretty much.
Very much.

33. Mood changes quickly and drastically.

Not at all.
Just a little.
Pretty much.
Very much.

34. Doesn’t like or doesn’t follow restrictions.

Not at all.
Just a little.
Pretty much.
Very much.

35. Fights constantly.

Not at all.
Just a little.
Pretty much.
Very much.

36. Doesn’t get along well with brothers or sisters.

Not at all.
Just a little.
Pretty much.
Very much.

37. Easily frustrated in efforts.

Not at all.
Just a little.
Pretty much.
Very much.

38. Disturbs other children.

Not at all.
Just a little.
Pretty much.
Very much.

39. Basically an unhappy child.

Not at all.
Just a little.
Pretty much.
Very much.

40. Problems with eating (poor appetite, up between bites).

Not at all.
Just a little.
Pretty much.
Very much.

41. Stomach aches.

Not at all.
Just a little.
Pretty much.
Very much.

42. Problems with sleep (can’t fall asleep, up too early, up at night).

Not at all.
Just a little.
Pretty much.
Very much.

43. Other aches and pains.

Not at all.
Just a little.
Pretty much.
Very much.

44. Vomiting or nausea.

Not at all.
Just a little.
Pretty much.
Very much.

45. Feels cheated in family circle.

Not at all.
Just a little.
Pretty much.
Very much.

46. Boasts and brags.

Not at all.
Just a little.
Pretty much.
Very much.

47. Lets self be pushed around.

Not at all.
Just a little.
Pretty much.
Very much.

48. Bowel problems (frequently loose, irregular habits, constipation)

Not at all.
Just a little.
Pretty much.
Very much.

Vanderbilt Parent Assessment Scale

Each rating should be considered in the context of what is appropriate for the age of your child

Is this evaluation based on a time when the child

was on medication
was not on medication.

Please answer all questions

1. Does not pay attention to details or makes careless mistakes with, for example, homework.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

2. Has difficulty keeping attention to what needs to be done.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

3. Does not seem to listen when spoken to directly.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

4. Does not follow through when given directions and fails to finish activities (not due to refusal or misunderstanding).

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

5. Has difficulty organizing tasks and activities.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

7. Loses things necessary for tasks or activities (toys, assignments, pencils, or books).

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

8. Is easily distracted by noises or other stimuli.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

9. Is forgetful in daily activities.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

Total of Question 1 to 9

10. Fidgets with hands or feet or squirms in seat.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

11. Leaves seat when remaining seated is expected.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

12. Runs about or climbs too much when remaining seated is expected.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

13. Has difficulty playing or beginning quiet play activities.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

14. Is “on the go” or often acts as if “driven by a motor.”

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

15. Talks too much.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

16. Blurts out answers before questions have been completed

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

17. Has difficulty waiting his/her turn.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

18. Interrupts or intrudes in on others’ conversations and/or activities.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

Total of Question 10 to 18

19. Argues with adults.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

20. Loses temper

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

21. Actively defies or refuses to go along with adults’ requests or rules

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

22. Deliberately annoys people.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

23. Blames others for his or her mistakes or misbehaviors.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

24. Is touchy or easily annoyed by others.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

25. Is angry or resentful.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

26. Is spiteful and wants to get even

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

Total of Question 19 to 26

27. Bullies, threatens, or intimidates others

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

28. Starts physical fights

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

29. Lies to get out of trouble or to avoid obligations (i.e. “cons” others).

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

30. Is truant from school (skips school) without permission.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

31. Is physically cruel to people

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

32. Has stolen things that have value.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

33. Deliberately destroys others’ property.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

34. Has used a weapon that can cause serious harm (bat, knife, brick, gun).

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

35. Is physically cruel to animals.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

36. Has deliberately set fires to cause damage

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

37. Has broken into someone else’s home, business, car.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

38. Has stayed out at night without permission

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

39. Has run away from home overnight.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

Total of Question 27 to 39

40. Has forced someone into sexual activity.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

41. Is fearful, anxious, or worried.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

42. Is afraid to try new things for fear of making mistakes.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

43. Feels worthless or inferior.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

44. Blames self for problems, feels guilty.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

45. Feels lonely, unwanted, or unloved; complains that “no one loves him/her”).

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

46. Is sad, unhappy, or depressed.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

47. Is self-conscious or easily embarrassed.

0 (Neverr)
1 (Occasionally)
2 (Often)
3 (Very Often)

Total of Question 40 to 47

Performance

Severity or Impairment

Considering your total experience with this child, how severely impaired is he/she at this time?
Compare this child to average normal children you are familiar with from your totality of
experience. Please circle the number that best describes this child.

Severity or Impairment

1 (Normal, No Impairment) => Symptoms are not present any more than expected (of a typical child of the same age and gender in the same situations) and do not produce impairment of normal functioning at home or at school
2 (Slight Impairment) => Symptoms are present a little more frequently or intensely than expected (of a typical child of the same age and gender in the same situations) and only rarely produce impairment of normal functioning at home or school
3 (Mild Impairment) => Symptoms are present somewhat more frequently or intensely than expected (of a typical child of the same age and gender in the same situations) and only sometimes produce impairment of normal functioning at home or school.
4 (Moderate Impairment) => Symptoms are present a lot more frequently or intensely than expected (of a typical child of the same age and gender in the same situations) and usually produce impairment of normal functioning at home or school.
5 (Severe Impairment) => Symptoms are present a great deal more frequently or intensely than expected (of a typical child of the same age and gender in the same situations) and most of the time produce impairment of normal functioning at home or school.
6 (Very Severe Impairment ) => Symptoms are present so much more frequently or intensely than expected (of a typical child of the same age and gender in the same situations) that they almost always produce impairment of normal functioning at home or school.
7 (Maximal, Profound Impairment) => Symptoms are present so frequently or intensely that they produce significant and pervasive impairment, which creates a crisis requiring immediate action to prevent serious deterioration, to avoid danger, or to prevent harm.

Terms and conditions

Accept the terms and conditions

Call: 916-999-1418

Connors Parent Questionnaire

Vanderbilt Parent Assessment Scale

Performance

Severity or Impairment