Pediatric Symptom Checklist-17 (PSC-17) – Youth INSTRUCTIONS: Please select the responses that best fit you. Hub Assigned ID(Required) 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#.HiddenInternalizing - positive if 5 or greaterI1. Do you feel sad, unhappy?(Required) 0-Never 1-Sometimes 2-Often I2. Do you feel hopeless?(Required) 0-Never 1-Sometimes 2-Often I3. Do you feel down on yourself?(Required) 0-Never 1-Sometimes 2-Often I4. Do you worry a lot?(Required) 0-Never 1-Sometimes 2-Often I5. Do you seem to be having less fun?(Required) 0-Never 1-Sometimes 2-Often HiddenAttention - positive if 7 or greaterA6. Are you fidgety, unable to sit still?(Required) 0-Never 1-Sometimes 2-Often A7. Do you daydream too much?(Required) 0-Never 1-Sometimes 2-Often A8. Do you distract easily?(Required) 0-Never 1-Sometimes 2-Often A9. Do you have trouble concentrating?(Required) 0-Never 1-Sometimes 2-Often A10. Do you act as if driven by a motor?(Required) 0-Never 1-Sometimes 2-Often HiddenExternalizing - positive if 7 or greaterE11. Do you fight with other children?(Required) 0-Never 1-Sometimes 2-Often E12. Do you not listen to rules?(Required) 0-Never 1-Sometimes 2-Often E13. Do you not understand other people’s feelings?(Required) 0-Never 1-Sometimes 2-Often E14. Do you tease others?(Required) 0-Never 1-Sometimes 2-Often E15. Do you blame others for your troubles?(Required) 0-Never 1-Sometimes 2-Often E16. Do you refuse to share?(Required) 0-Never 1-Sometimes 2-Often E17. Do you take things that do not belong to you?(Required) 0-Never 1-Sometimes 2-Often
