Behavioural Assessment - Vindland

Assessment 1 of 39

Form Instructions & Things to Know

How to fill this form:
  • Read each question carefully before selecting an answer.
  • Select the most accurate option based on your observations.
  • Do not skip questions; every response helps in the assessment.
Things to know:
10-15 Mins

Estimated completion time.

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Note: This is a screening and assessment tool, not clinical (medical).

First, please provide your contact information.

Information about the individual being assessed.

1. He/she is overly needy or dependent. Examples: Insists on help even when he/she does not need it, clings to parent or teacher.
2. He/she has eating problems. Examples: Overeats, refuses to eat, will only eat one or two things, hoards food.
3. He/she has sleep problems. Examples: Walks in his/her sleep, has a lot of nightmares, sleeps way more or less than others his/her age.
4. Refuses to go to school or work, or has to come home, because of worrying, sadness, nervousness, etc.
5. He/she is extremely anxious or nervous.
6. He/she cries or is sad for no clear reason.
7. He/she voids interacting with others (withdraws, prefers to be alone, etc.).
8. He/she lack interest in doing things that he/she enjoys or used to enjoy.
9. He/she is extremely fearful of one or more common objects or situations. Examples: Heights, snakes, elevators.
10. He/she worries for no clear reason
11. He/she is very irritable or moody.
12. Feels helpless or hopeless. Example: Says that things are bad and will never get better.
13. Complains of feeling sick, exhausted, or in pain, even though there is no medical reason.
14. He/she has temper tantrums: Screams, cries, kicks, etc.
15. He/she disobeys those in authority
16. Bullies others physically or with words.
17. Lies, cheats, or steals.
18. He/she is physically aggressive. Examples: Hits, kicks, bites.
19. He/she is stubborn or argues.
20. He/she is verbally abusive: Hurts others on purpose with insults, put-downs, etc.
21. Breaks rules or laws because of peer pressure.
22. He/she is much more active or restless than others his/her age. Examples: Moves all the time, cannot sit still, fidgets.
23. Takes or uses school or work property when not allowed. Examples: Books, office supplies.
24. Destroys his/her own or someone else's possessions on purpose.
25. He/she gets fixated on objects or parts of objects. Examples: Stares at spinning wheels or fan blades, lines up objects, flips light switches over and over.
26. Talks about hearing voices that others do not hear, or seeing things that others do not see.
27. Harms himself/herself. Examples: Bangs his/her head, hits or bites self, cuts self, tears at skin, pulls out his/her hair.
28. Uses strange or repetitive speech. Examples: Has conversations with himself/herselfin public, says things that make no sense, repeats the same thing over and over.
29. Repeats physical movements over and over. Examples: Rocks back and forth, spins, flaps hands.
30. He/she eats non-food items such as dirt, paste, or soap.
31. He/she gets so fixated on a particular topic that it annoys others. Examples: Trains, reptiles, maps, subway systems
32. Talks about killing himself/herself or has tried to kill self.
33. Leaves home, school, or care suddenly, runs off without thinking about safety
34. He/she threatens to hurt or kill someone.
35. He/she get tricked or manipulated by others into doing something that could seriously harm him or her, or someone else.
36. Use this space for any general comments you want to make about the person, or about this form.