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    Symptom Checklist WSR-II

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    celena new junk
    This document contains a checklist for assessing symptoms across several domains including attention, hyperactivity, oppositional behavior, development, autism, motor skills, psychosis, depression, mood regulation, suicide, anxiety, stress, sleep, eating, conduct, substance use, addictions, and personality. Respondents are asked to rate each item on a scale from none to severe to indicate the level of difficulty.

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    Symptom Checklist WSR-II

    Uploaded by

    celena new junk
    339 views5 pages
    This document contains a checklist for assessing symptoms across several domains including attention, hyperactivity, oppositional behavior, development, autism, motor skills, psychosis, depression, mood regulation, suicide, anxiety, stress, sleep, eating, conduct, substance use, addictions, and personality. Respondents are asked to rate each item on a scale from none to severe to indicate the level of difficulty.

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    Rating scale

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    This document contains a checklist for assessing symptoms across several domains including attention, hyperactivity, oppositional behavior, development, autism, motor skills, psychosis, depression, mood regulation, suicide, anxiety, stress, sleep, eating, conduct, substance use, addictions, and personality. Respondents are asked to rate each item on a scale from none to severe to indicate the level of difficulty.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    339 views5 pages

    Symptom Checklist WSR-II

    Uploaded by

    celena new junk
    This document contains a checklist for assessing symptoms across several domains including attention, hyperactivity, oppositional behavior, development, autism, motor skills, psychosis, depression, mood regulation, suicide, anxiety, stress, sleep, eating, conduct, substance use, addictions, and personality. Respondents are asked to rate each item on a scale from none to severe to indicate the level of difficulty.

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    WEISS SYMPTOM RECORD II

    PATIENT: _____________________________________________________________________________________________

    INFORMANT: __________________________________________________________________________________________

    This is a problem checklist. Not all the items will be appropriate for you. Please indicate the level of difficulty associated with each
    item:
    None: This is not a problem or concern. Any challenges are age-appropriate
    Mild: Some difficulty (somewhat)
    Moderate: This is a problem (pretty much)
    Severe: This is a serious problem (very much)
    NA: Not applicable. Check this column if the item is not a problem or not relevant to you.

    Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) N/A

    ATTENTION

    Attention to details or makes careless mistakes

    Holding attention or remaining focused

    Listening or mind seems elsewhere

    Instructions or finishing work

    Organizing (e.g. time, messy, deadlines)

    Avoids or dislikes activities requiring effort

    Loses or misplaces things

    Easily distracted

    Forgetful (e.g. chores, bills, appointments)

    HYPERACTIVITY AND IMPULSIVITY

    Fidgets or squirms

    Trouble staying seated

    Runs about or feels restless inside

    Loud or difficulty being quiet

    Often on the go

    Talks too much

    Blurts out comments

    Dislikes waiting (e.g. taking turns or in line)

    Interrupts or intrudes on others (e.g. butting in)

    OPPOSITIONAL

    Loses temper

    Easily annoyed

    Angry and resentful

    Argues

    Defiant

    Deliberately annoys other people

    Blames other people rather than themselves

    Spiteful

    1
    WEISS SYMPTOM RECORD II
    Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) N/A

    DEVELOPMENT AND LEARNING

    Wetting, (after age 5)

    Soiling (after age 4)

    Reading

    Spelling

    Math

    Writing

    AUTISM SPECTRUM

    Difficulty with talking back and forth

    Unusual eye contact or body language

    Speech is odd (monotone, unusual words)

    Restricted, fixed, intense interests

    Odd, repetitive movements (e.g. flapping)

    Does not easily "chit chat"

    MOTOR DISORDERS

    Repetitive noises (e.g. sniffing, throat clearing)

    Repetitive movements (blinking, shrugging)

    Clumsy

    PSYCHOSIS

    Hearing voices that are not there

    Seeing things that are not there

    Scrambled thinking

    Paranoia (feeling people are against you)

    DEPRESSION

    Sad or depressed most of the day

    Lack of interest or pleasure most of the day

    Weight loss, weight gain or change in appetite

    Difficulty sleeping or sleeping too much

    Agitated

    Slowed down

    Feels worthless

    Tired, no energy

    Hopeless, pessimistic

    Withdrawal from usual interests/people

    Decrease in concentration

    2
    WEISS SYMPTOM RECORD II
    Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) N/A

    MOOD REGULATION

    Distinct period(s) of intense excitement

    Distinct period(s) of inflated self-esteem, grandiose

    Distinct period(s) of increased energy

    Distinct period(s) of decreased need for sleep

    Distinct Period(s) of racing thoughts or speech

    Irritable behaviour that is out of character

    Rage attacks, anger outbursts, hostility

    SUICIDE

    Suicidal thoughts

    Suicide attempt(s) or a plan

    ANXIETY

    Intense fears (e.g. heights, crowds, spiders)

    Fear of social situations or performing

    Panic attacks

    Fear of leaving e.g. the house, public transportation.

    Worrying and/or anxious most days

    Nervous, can't relax

    Obsessive thoughts (e.g. germs, perfectionism)

    Compulsive rituals (e.g. checking, hand washing)

    Hair pulling, nail biting or skin picking

    Preoccupation with physical complaints

    Chronic pain

    STRESS RELATED DISORDERS

    Physical abuse

    Sexual abuse

    Neglect

    Other severe trauma

    PTSD

    Flashbacks or nightmares

    Avoidance

    Intrusive thoughts of traumatic events


    WEISS SYMPTOM RECORD II
    Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) N/A

    SLEEP

    Trouble falling asleep or staying asleep

    Excessive daytime sleepiness

    Snoring or stops breathing during sleep

    EATING

    Distorted body image

    Underweight

    Binge eating

    Overweight

    Eating too little or refusing to eat

    CONDUCT

    Verbal aggression

    Physical aggression

    Used a weapon against people (stones, sticks etc.)

    Cruel to animals

    Physically cruel to people

    Stealing or shoplifting

    Deliberately sets fires

    Deliberately destroys property

    Frequent lying

    Lack of remorse or guilt

    Lack of empathy or concern for others

    SUBSTANCE USE

    Misuse of prescription drugs

    Alcohol > 14 drinks/week or 4 drinks at once

    Smoking or tobacco use

    Marijuana

    Other street drugs

    Excessive over the counter medications

    Excessive caffeine (colas, coffee, tea, pills)


    WEISS SYMPTOM RECORD II
    Difficulty with: None (0) Mild (1) Moderate (2) Severe (3) N/A

    ADDICTIONS

    Gambling

    Excessive internet, gaming or screen time

    Other addiction _______________________________

    PERSONALITY

    Self-destructive

    Stormy, conflicted relationships

    Self-injurious behaviour (e.g. cutting)

    Low self-esteem

    Manipulative

    Self-centered

    Arrogant

    Suspicious

    Deceitful with no remorse

    Breaking the law or antisocial behaviour

    Tends to be a loner

    OTHER (Please indicate any other difficulties)

    This scale is copyrighted by Margaret Danielle Weiss, MD PhD. The scale can be used by clinicians and researchers free of charge and
    can be posted on the Internet or replicated as needed. Please contact Dr. Weiss at margaret.weiss@icloud.com if you wish to post the
    scale on the Internet, use it in research or plan to create a translation.

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