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PROBLEM CHECKLIST OF AN EARLY CHILDHOOD

 

NAME OF THE CHILD:
AGE:
BIRTH DATE:

            Instruction: Put a check in the space provided in every number if the child          shows the behavior mention in the following checklist.

PHYSICAL ASPECT

            _________Aches or pains

            _________Hyperactive

            _________Gets hurt a lot, accident-prone

            _________Headaches (without medical cause)

            _________Problems with eyes without medical cause

EMOTIONAL ASPECT

            _________Cries a lot

            _________Feelings are easily hurt

            _________Angry moods

            _________Screams a lot

            _________Shows too little fear of getting hurt

SOCIAL ASPECT

            _________Avoids looking others in the eye

            _________Clings to adults or too dependent

            _________Doesn’t answer when people talk to him/her

            _________Doesn’t get along with other children

            _________Selfish or won’t share

INTELLECTUAL ASPECT

            _________Daydreams or gets lost in his/her thoughts

            _________Difficulty following directions

            _________Fails to carry out assigned tasks

            _________Afraid to try new things

            _________Can’t concentrate, can’t pay attention for long

MORAL ASPECT

            _________Cruel to animals

            _________Destroys his/her own things

            _________Destroys property belonging to others

            _________Cruelty, bullying, or meanness to others

            _________Disturbs other children

 

 

Signature of the Observer: ­­­­­­­­­­­­­­­­­­­­­­­­­­­________________________

Date: ___________

 

 

 

 

Prepared by:

            Ms. Maria Lorena R. Obinguar

            BEED 3A