Initial Psychological Assessment

Instructions: Below is a list of questions that relate to life experiences among people who have been diagnosed with common mental health disorders such as depression, anxiety, ADHD, substance abuse, etc. Please read each question carefully, and indicate how severe (7 being the highest) you have experienced the same or similar challenges in the past few months. Your privacy is important to us. All results are completely anonymous.

Rank Each of the Issues From 1 to 7 in the Fields Below

Name

Age

Date

Thinks clearly / Difficulty Thinking

Creative Problem Solver / Gets Stuck WIth Problems

Plans Effectively / Doesn't Plan

Good decision-maker / Can't make up mind

Detail oriented / Struggles with details

Maintains attention on task / Easily distracted from task

Good listener / Poor Listner

Follows instructions / Doesn't follow instructions

Remembers tasks & appointments / Forgets tasks & appointments

Alert to surroundings / Day dreams

Completes tasks / Starts but doesn't finish

Keeps track of items / Loses or misplaces things

Positive and happy / Negative and unhappy

Comfortable in social situations / Uncomfortable socially

Feels good about self / Poor self image

Handles new situations confidently / Dislikes new situations

Energetic and enthusiastic / Low energy

Eats appropriately / Eats little or overeats

Sleeps easily & gets up easily / Sleeps little or too much

Generally calm & stable / Agitated or irritable

Positive about the future / Hopeless about future

Finds enjoyment & pleasure in life / Can't see positives in life

Sees positive traits in others / Negative view of others

Happy & joyful / Flat or unhappy

Laughs easily & appropriately / Rarely laughs

Experiences excitement in life / Finds life boring

Has good vocabulary & uses it well / Limited vocabulary

Speaks in complete & orderly way / Disorganized verbal expression

Clear, expressive writer / Writes poorly

Accurate grammar & punctuation / Makes grammar & punctuation errors

Self-starter who gets things done / Unmotivated

Participates in recreational activity / Doesn't participate

Interested in other people / Finds others boring

Has goals and plans in life / Just goes through life

Able to deviate from routine / Stuck in routine ways of doing things

Tolerates disorder / Greatly disturbed by disorder

Allows others control / Needs to control people or situations

Not perfectionist / Demands perfection

Balances work with social life / Obsession with work, crowds & social life

Adjusts to new experience / Can't shift patterns for doing things

Flexible behavior speech patterns / Compulsive repetition of speech or behaviors

Does things quickly & accurately / Works very slowly to be sure things are right

Doesn't have obsessive thoughts / Can't stop unpleasant, repetitive thoughts

Flexible / Stubborn

Follows the rules / Disobedient

Accepts authority / Rebels against authority

Not argumentative / Argues for the sake of arguing

Doesn't do things to annoy others / Does things just to bother others

Able to control temper / Poor temper control

Accepts responsibility for own actions / Blames others

Not easily annoyed / Annoyed by small things

Calm and positive / Angry or resentful

Treats others compassionately / Does things to hurt others

Controls use of substances / Addictive with certain substances

Controls behaviors / Can't control certain behaviors (e.g. gambling)

Able to stop use of substances / Feels discomfort when attempting to stop

Thinks before acting / Impulsive actions

Controls temper in public / Loses temper in public

Appropriate expressions of sexuality / Inappropriate sexual activity

Does not argue or fight / Argumentative, gets into fights

Controls physical behavior when angry / Physically out of control when angry

Does not interrupt in conversations / Interrupts often

Can wait in line or do things in turn / Impatient when required to wait

Need not be center of attention / Seeks attention in groups

Respects feelings of others / Speaks without thinking of others feelings

Finishes tasks without jumping around / Can't stay on task to completion

Feels fear when appropriate / Not afraid when others would be

Feels anger when appropriate / Does not get angry when others would

Feels anxious when appropriate / Doesn't get nervous when others would

Not needlessly frightened / Afraid in situations where others are not

Not needlessly angry / Gets angry when it is not appropriate

Anger level is appropriate to the cause / Overreacts to anger-provoking situations

Recalls childhood clearly / Has lost periods of time from childhood

Feels pain appropriately / Does not feel pain when others would

Does not hear voices in head / Hears voices inside head

Able to sit still / Fidgety and restless

Appropriate level of energy / Sluggish or low energy

Talks appropriately / Talks excessively or very little

Talks at reasonable pace / Talks very fast or very slowly

Can entertain self quietly / Can't relax or work play quietly

Able to start new tasks / Can't find the energy to get things started

Clear handwriting / Messy handwriting

Able to do fine-motor tasks / Difficulty with fine-motor tasks

Graceful and coordinated / Clumsy, breaks or bumps into things

Balanced and rhythmic / Poor balance or rhythm

Initial Psychological Assessment

Rank Each of the Issues From 1 to 7 in the Fields Below

How Can We Help You?