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HOME
Self assessment tools
Adolescent self-assessment
Adolescent self-assessment tool
Name*
Email address*
Contact number
Location*
Over the past two weeks:
Have you felt there is no hope?
Yes
No
Have you felt guilty all the time?
Yes
No
Have you felt bad about yourself or that you have let others down?
Yes
No
Have you felt that your pain and suffering is unmanageable?
Yes
No
Have you battled to sleep at night? Or have you been sleeping too much?
Yes
No
Have you experienced loss of appetite or unintentional weight loss/gain?
Yes
No
Has your enjoyment of things that you used to enjoy decreased?
Yes
No
Have you felt trapped, helpless and alone?
Yes
No
Have there been times when you have a lot of energy and times when you have none?
Yes
No
Have there been vast variation in the quality or quantity of the work that you have produced?
Yes
No
Have you experienced difficulty concentrating on normal daily tasks e.g. cooking or reading?
Yes
No
Have you suffered a trauma?
Yes
No
Has someone raised concern about your drinking or drugging?
Yes
No
Have you ever stayed away from school, work, college, or university due to drinking or drugging?
Yes
No
Is your drinking or drugging affecting your relationships?
Yes
No
Have you ever felt guilty about your behaviour when drinking or drugging?
Yes
No
Do you drink or drug to escape your worries or troubles?
Yes
No
Have you ever gotten into financial difficulties because of drinking or drugging?
Yes
No
Has your ambition or drive decreased since drinking or drugging?
Yes
No
Is drinking or drugging jeopardising your job or business?
Yes
No
Have you ever had memory loss due to drinking or drugging?
Yes
No
Do you drink/take drugs to build up your self- confidence?
Yes
No
Have you ever tried to control, reduce, or stop your drinking or drugging?
Yes
No
Have you come into contact with the police/legal services due to your drinking or drugging?
Yes
No
Have you needed to increase your drinking or drug quantity to achieve the desired effect?
Yes
No
Have you continued to use alcohol or drugs in situations where it puts yourself/others at risk e.g. whilst driving?
Yes
No
Do you eat only “safe” foods, low in calories and fat?
Yes
No
Have you developed rituals with food, such as cutting food into small pieces or measuring food?
Yes
No
Do you spend more time playing with food than eating it?
Yes
No
Have you felt the need to exercise excessively, after or before eating?
Yes
No
Do you dress in layers to hide weight loss or weight gain?
Yes
No
Have you been spending less time with family and friends?
Yes
No
Do your eating habits interrupt your daily functioning, e.g. eating out with friends, or attending a social function?
Yes
No
Do you spend a lot of time thinking about and planning what you can eat?
Yes
No
Do you make trips to the bathroom after meals?
Yes
No
Do you take laxatives or diuretics after meals?
Yes
No
Are you eating faster than other people?
Yes
No
Have you ever stolen or hoarded food?
Yes
No
Do you perceive yourself as fat despite others saying otherwise?
Yes
No
Is your self-confidence based on your weight?
Yes
No
Do you weigh yourself constantly?
Yes
No
Do you feel guilty after you have eaten?
Yes
No
Is your BMI (body mass index) lower than 18? BMI = (weight) (height squared)
Yes
No
Do you feel you spend many hours a day and many days a week worrying about events or activities e.g. work or school performance?
Yes
No
Are you finding it difficult to control your worrying thoughts?
Yes
No
Does your worrying result in restlessness or feeling tense, on a daily basis?
Yes
No
Is it difficult to concentrate on tasks because your worrying thoughts interfere?
Yes
No
Do you or others find yourself easily irritable?
Yes
No
Do your muscles or body feel tense from stress?
Yes
No
Are you struggling to sleep at night (battling to fall asleep, waking up often, or having restless sleep)?
Yes
No
Is your worrying interrupting your daily activities or relationships?
Yes
No
Have you noticed any of these traits in yourself/your teenager?
Distancing from the family
Yes
No
Lying
Yes
No
Isolating
Yes
No
Drop in academic performance
Yes
No
School refusing
Yes
No
Poor grooming and dress
Yes
No
Negative mood or attitude
Yes
No
New friends (wrong crowd)
Yes
No
Lack of motivation
Yes
No
Self-destructive behaviour
Yes
No
Suicidal ideas
Yes
No
Anger outbursts
Yes
No
Drug use
Yes
No
Cutting/self-harming
Yes
No
Sexual promiscuity
Yes
No
Running away
Yes
No
Alcohol abuse
Yes
No
Lack of self-esteem
Yes
No
Parental distrust
Yes
No
Refusal to eat/overeating
Yes
No
Manipulative and deceitful behaviour
Yes
No
Calculate
×
Results
Answers: Yes:
| No:
Unanswered:
Based on your answers, we recommend that you check 'Yes' so that we may call/email you with further assistance. If you would like us to get in touch, please check 'Yes' so that we may call/email you with further assistance. Alternatively, call us on 0861 4357 87
.
Yes, please email me
Yes, please call me
Yes, please email me
Yes, please call me
Contact number
No thank you
No thank you
Related disorders
Adolescent disorders
Other disorders
Ageing disorders
Anxiety disorders
Bipolar mood disorder
Depression
Eating disorders
Postnatal depression/Postpartum psychosis
Post-traumatic stress disorder
Substance abuse / Addiction
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