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Informal Child & Adolescent Depression Checklist (print to use)

The following informal checklist does not have a scoring key. These are, however, all important dimensions of depression that should be discussed with a counselor or psychologist.

Put an “X” in the appropriate box:

Symptom

None

Just a Little

Pretty much

Very Much

 

 

 

 

 

Child complains of depression or feeling sad

 

 

 

 

Child is very irritable or angry daily or several times a week

 

 

 

 

Child has low energy and seems dull or listless

 

 

 

 

Child has a poor sleeping pattern

 

 

 

 

Child has no close friends

 

 

 

 

Child feels hopeless about the future (“no matter how hard I try it will never work out”)

 

 

 

 

* Child cuts on self or deliberately mutilates skin  (e.g., burning or scraping and etc.) Call a therapist.

 

 

 

 

* Child makes direct or indirect reference to suicide (e.g., “I wish I hadn’t been born,” “You’d be better off without me.”   Call a therapist.

 

 

 

 

None of these items are “normal” for childhood or adolescence All are indicators of depression or may overlap with a different psychological or medical problem.  Any marks in the Pretty Much or Very Much column should get immediate attention.  Consider seeing a trained counselor or psychologist for markings of “Just a Little."

·        Any suicidal ideation whether direct or indirect (even marked “Just a Little”) should be evaluated immediately by a trained counselor or psychologist.

·        Self-Mutilation should also be referred to a trained counselor or psychologist with a “Just a Little” rating.

 Depression is a major psychiatric problem that can get worse.  It should not be ignored.   

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