Pediatric Symptom Checklist-17 (PSC-17) – Youth

INSTRUCTIONS: Please select the responses that best fit you.

This code will be provided by your UF Care Coordinator. Please DO NOT use Patient's Name or Date of Birth, DO NOT use Patient's Medical Record Number, DO NOT use Patient's SS#.

Internalizing - positive if 5 or greater

I1. Do you feel sad, unhappy?(Required)
I2. Do you feel hopeless?(Required)
I3. Do you feel down on yourself?(Required)
I4. Do you worry a lot?(Required)
I5. Do you seem to be having less fun?(Required)

Attention - positive if 7 or greater

A6. Are you fidgety, unable to sit still?(Required)
A7. Do you daydream too much?(Required)
A8. Do you distract easily?(Required)
A9. Do you have trouble concentrating?(Required)
A10. Do you act as if driven by a motor?(Required)

Externalizing - positive if 7 or greater

E11. Do you fight with other children?(Required)
E12. Do you not listen to rules?(Required)
E13. Do you not understand other people’s feelings?(Required)
E14. Do you tease others?(Required)
E15. Do you blame others for your troubles?(Required)
E16. Do you refuse to share?(Required)
E17. Do you take things that do not belong to you?(Required)