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Youth self report- pentru varstele 11-18 ani

Psihologie












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Youth self report- pentru varstele 11-18 ani

Numele intreg :

Baiat                            Fata



Varsta:

Data de azi:                                                               .

Data ta de nastere :                                                       .

In ce clasa esti la scoala?:

             4            7         10

             5            8         11

             6            9         12

             scoala post liceala, specifica :                                        .

             nu merg la scoala

Te rog sa completezi acest formular care sa arate punctul tau de vedere, chiar daca

 altii s-ar putea sa nu fie de acord

I.                    Te rog sa completezi care din sporturi iti place sa le practici. De exemplu : inotul, baseball, skating, ciclism, pescuit, etc.

Niciunul

                        a.                                                                   .

                        b.                                                                   .

                        c.                                                                   .

Comparativ cu ceilalti de varsta ta cat timp iti petreci cu fiecare sport ?

Mai putin        Mediu           Mai mult

                                          decat mediu                       decat mediu

a

b

c                                

Comparativ cu ceilalti de varsta ta cat cat de bine te 16216h722q descurci cu fiecare sport ?

Sub medie        Mediu          Peste medie

a

b

c

II.                 Te rog sa completezi hobby-urile tale favorite, activitati si jocuri, altele decat sporturi. De exemplu : sa joci carti, citit carti, pian, masini, jocuri de construit, etc.(Nu include ascultatul la radio sau privitul la TV)

Niciunul

                        a.                                                                   .

                        b.                                                                   .

                        c.                                                                   .

Comparativ cu ceilalti de varsta ta cat timp iti petreci cu fiecare ?

Mai putin        Mediu           Mai mult

                                          decat mediu                       decat mediu

a

b

c

Comparativ cu ceilalti de varsta ta cat cat de bine te 16216h722q descurci cu fiecare ?

Sub medie        Mediu          Peste medie

a

b

c

III.               Te rog sa completezi orice organizatii, cluburi, echipe sau grupuri din care faci parte.

Niciunul

                        a.                                                                   .

                        b.                                                                   .

                        c.                                                                   .

Comparativ cu ceilalti de varsta ta cat de activ esti in fiecare ?

Mai putin        Mediu           Mai mult

                                              activ                                    activ

a

b

c

IV.              Te rog sa completezi orice slujbe sau indatoriri pe care le ai. De exemplu : sa distribui ziare, ingrijitor la copii, sa faci patul, sa lucrezi intr-un magazin. ( Include atat slujbele sau indatoririle platite cat si pe cele neplatite ).

Niciunul

                        a.                                                                   .

                        b.                                                                   .

                        c.                                                                   .

Comparativ cu ceilalti de varsta ta cat cat de bine le indeplinesti ?

Sub medie        Mediu          Peste medie

a

b

c

V.                 1. Cam cati prieteni apropiati ai ? ( Nu include frati si surori)

Niciunul                        1                      2 sau 3             4 sau mai multi

                  2. Cam de cate ori pe saptamana faci lucruri cu orice prieteni inafara orelor de scoala ?

                     ( Nu include frati si surori)

Mai putin de 1              1 sau 2 ori              3 sau mai multe ori

VI.              Comparativ cu ceilalti de varsta ta :

Mai rau     Mediu     Mai bine           

a.Cat de bine te intelegi cu fratii si surorile ?                 

b.Cat de bine te intelegi cu alti copii ?                            

c.Cat de bine te intelegi cu parintii ?                               

d.Cat de bine faci lucrurile de unul singur ?                   

                                                Nu am frati sau surori

VII.                  Performanta la materiile de scoala :

Nu merg la scoala pentru ca :                                                                                      .

                                                                                   Corigent  Sub medie     Medie    Peste medie

a. Limba si literatura romana                      

b. Istorie sau Stiinte sociale                        

c. Aritmetica sau Matematica                    

d. Stiinta                             

                        e.                                                       .

                        f.                                                       .

                        g.                                                      .  ( Alte domenii academice- de ex. curs de

calculatoare, limbi straine, afaceri,etc. Nu includeti gimnastica, cumpraturi, soferie, etc.)

            Ai vreo boala, incapacitate sau handicap ?

                                                                                    Nu                               Da         

- te rog descrie :

  

_                                                                                                                                                    .                                                                     

 

                                                                                                                                                     .    

Te rog sa descrii orice preocupare sau problema pe care o ai in legatura cu scoala :

                                                                                                                                                 .       

                                                                                                                                                 .       

Te rog sa descrii orice alta preocupare ai :    

                                                                                                                                                  .       

                                                                                                                                                 .       

Te rog sa descrii cele mai bune lucruri despre tine:



                                                                                                                                                  .       

                                                                                                                                                  .       

Mai jos este o lista cu afirmatii care descriu copiii. Pentru fiecare afirmatie care te descrie asa cum esti acum sau cum ai fost in ultimele 6 luni, te rog sa umpli bulina de dedesubtul cifrei 2 daca afirmatia este pentru tine foarte adevarata sau adesea adevarata. Umple bulina de dedesubtul cifrei 1 daca afirmatia este pentru tine intrucatva sau cateodata adevarata. Daca afirmatia nu este adevarata pentru tine, umple bulina de dedesubtul cifrei 0 .

0 = Nu este adevarat            1 = Intrucatva sau cateodata  adevarat            2 = Foarte sau adesea adevarat   

      0      1      2                                                                                                 0      1      2    

                              1.Ma port prea copilareste pentru varsta mea.                   10.Am probleme in a sta locului

      0      1      2                                                                                                 0      1      2    

                               2.Am o alergie (descrie):                                                       11.Sunt prea dependent de adulti

                                                                                                         .

                                                                                                         .

       0      1      2                                                                                                0      1      2    

                               3. Contrazic destul de mult                                                   12.Ma simt singur

      0      1      2                                                                                                 0      1      2    

                               4.Am astm bronsic                                                                  13.Ma simt confuz sau in ceata

      0      1      2                                                                                                 0      1      2    

                               5.Ma port ca si celalalt sex                                                    14.Plang mult

      0      1      2                                                                                                 0      1      2    

                               6.Imi plac animalele                                                                15.Sunt destul de onest

      0      1      2                                                                                                 0      1      2    

                               7.Ma laud (sunt laudaros)                                                    16.Sunt rau cu altii

      0      1      2                                                                                                 0      1      2    

                               8.Am probleme cu concentrarea sau pastrarea                             17.Visez mult cu ochii deschisi

                                     atentiei                               

      0      1      2                                                                                                 0      1      2    

                               9.Nu pot sa-mi scot din minte anumite ganduri:                         18.Incerc deliberat sa ma ranesc sau

                                      ( descrie ):                                                                                                sa ma omor

                                                                                                         .

                                                                                                         .

               

                

      0      1      2                                                                                                 0      1      2    

                               19.Incerc sa capat multa atentie                                                           40.Aud sunete sau voci pe care altii

        nu le cred (descrie):

                                                                                                                                                                                                      . 

                                                                                                                                                                                                      . 

      0      1      2                                                                                                 0      1      2    

                               20.Imi distrug propriile lucruri                                                                 41.Actionez fara sa ma opresc din

          gandire

 

      0      1      2                                                                                                 0      1      2    

                               21.Distrug lucrurile altora                                                     42.Prefer singur decat cu alti

      0      1      2                                                                                                 0      1      2    

                               22.Ma opun parintilor                                                                              43.Mint sau insel

      0      1      2                                                                                                 0      1      2    

                               23.Ma opun la scoala                                                                              44.Imi rod unghiile

      0      1      2                                                                                                 0      1      2    

                               24.Nu mananc asa bine cum as vrea                                      45.Sunt nervos sau tensionat            

      0      1      2                                                                                                 0      1      2    

                               25.Nu ma alatur altor copii                                                     46.Mi se contorsioneaza parti din

                                                                                                                                                       corp sau am miscari nervoase

                                                                                                                                                       (descrie):

                                                                                                                                                                                                      . 

                                                                                                                                                                                                      . 

      0      1      2                                                                                                 0      1      2    

                               26.Nu ma simt vinovat dupa ce fac lucruri                                            47.Am cosmaruri

                                       pe care nu ar trebui sa le fac           

      0      1      2                                                                                                 0      1      2    

                               27.Sunt gelos pe altii                                                                                48.Nu ma plac ceilalti copii

      0      1      2                                                                                                 0      1      2    

                               28.Sunt dornic sa-i ajut pe altii cand au nevoie                             49.Nu pot face lucruri mi bine decat

                                                                                                                                                         ceilalti copii                  

      0      1      2                                                                                                 0      1      2    

                               29.Mi-e frica de anumite animale, situatii sau                                 50.Sunt prea fricos sau anxios

                                       locuri, altele decat scoala (descrie):

                                                                                                         .

                                                                                                         .

      0      1      2                                                                                                 0      1      2    

                               30.Mi-e frica sa ma duc la scoala                                                          51.Ma simt confuz




      0      1      2                                                                                                 0      1      2    

                               31.Mi-e frica ca as putea sa gandesc sau sa                                         52.Ma simt prea vinovat

      0      1      2               fac lucruri rele                                                         0      1      2    

                               32.Simt ca trebuie sa fiu perfect                                                            53.Mananc prea mult

                         

      0      1      2                                                                                                 0      1      2    

                               33.Simt ca nimeni nu ma iubeste                                                          54.Ma simt extenuat

                                      

      0      1      2                                                                                                 0      1      2    

  34.Simt ca ceilalti se straduie sa ma prinda                                       55.Sunt supraponderal

      0      1      2                                                                                                 0      1      2    

                               35.Ma simt fara valoare sau inferior                                      56.Probleme fizice fara cauza

                                                                                                                                                        cunoscuta medicala:            

      0      1      2                                                                                                 0      1      2    

                               36.Ma ranesc accidental  destul de mult                                              a.dureri ( nu de stomac sau de

                                                                                                                                                                   cap)             

      0      1      2                                                                                                 0      1      2    

  37.Ma implic in multe batai                                                                b.dureri de cap

      0      1      2                                                                                                 0      1      2    

                               38.Sunt ironizat (rad de mine) de multe ori                                           c.greata, ma simt rau

      0      1      2                                                                                                 0      1      2    

                               39.Intru in anturaj cu copii care dau de necazuri                         d.probleme cu ochii (nu daca sunt

                                                                                                                                                    corectate cu ochelari (descrie):     

                                                                                                         .                                                                             .

                                                                                                         .                                                                              .

                

      0      1      2                                                                                                 0      1      2    

              e.eruptii sau alte probleme de piele                                                     71. Sunt prea sensibil sau usor de ranit

      0      1      2                                                                                                 0      1      2    

                            f.dureri de stomac sau crampe                                                                 72.Dau foc                                          

      0      1      2                                                                                                 0      1      2    

                            g.voma                                                                                         73.Nu pot lucra bine cu mainile

      0      1      2                                                                                                 0      1      2    

                            h.altele (descrie):                                                                                        74.Ma dau in spectacol sau

                                                                                                                                                       fac pe clovnul

                                                                                                         .                         

                                                                                                         .                         

      0      1      2                                                                                                 0      1      2    

                               57.Atac fizic oamenii                                                                               75.Sunt rusinos

      0      1      2                                                                                                 0      1      2    

                               58.Imi ciupesc pielea sau alte parti ale corpului                         76.Dorm mai putin decat alti copii

                                

      0      1      2                                                                                                 0      1      2    

                               59.Pot fi destul de prietenos                                                 77.Dorm mai mult decat ceilalti copii

    in cursul zilei si/sau noptii (descrie):

                                                           .

                                                                                                                                                                                                           .

      0      1      2                                                                                                 0      1      2    

                               60.Imi place sa incerc noi lucruri                                                          78.Am o imaginatie bogata

      0      1      2                                                                                                 0      1      2    

                               61.Prestanta mea la scoala este saraca                                                79.Am o problema de vorbire

       (descrie):  

                                                                                                                                                                                                              .

                                                                                                                                                                                                              .               

      0      1      2                                                                                                 0      1      2    

                               62.Sunt slab coordonat sau impiedicat                                                 80.Imi apar drepturile

      0      1      2                                                                                                 0      1      2    

                               63.Prefer copiii mai mari decat pe cei de varsta                         81.Fur de acasa

                                    mea                                                                                                            

      0      1      2                                                                                                 0      1      2    

                               64.Prefer copiii mai mici decat pe cei de varsta                         82.Fur din locuri altele decat acasa

                                       mea                                                                                                         



      0      1      2                                                                                                 0      1      2    

                               65.Refuz sa vorbesc                                                                                83.Adun lucruri de care n-am nevoie:

                                                                                                                                                         (descrie):

                                                                                                                                                                                                              .

                                                                                                                                                                                                              .

      0      1      2                                                                                                 0      1      2    

                               66.Repet anumite acte la nesfirsit (descrie):                                         84.Fac lucruri pe care alti oameni

                                                                                                         .                                   cred ca sunt ciudate(descrie):

                                                                                                         .                                                                                  .

                                                                                                                                                                                                              .

      0      1      2                                                                                                 0      1      2    

                               67.Fug de acasa                                                                       85.Am ganduri pe care alti oameni

                                                                                                                                                       le-ar considera ciudate (descrie):

                                                                                                                                                                                                              .

                                                                                                                                                                                                              .

      0      1      2                                                                                                 0      1      2    

                               68.Tip frecvent                                                                                        86.Sunt incapatanat

      0      1      2                                                                                                 0      1      2    

                               69.Sunt secretos sau tin lucrurile pentru mine                            87.Dispozitiile si sentimentele se                            

      0      1      2                                                                                                 0      1      2             schimba rapid

                               70.Vad lucruri pe care ceilalti cred ca nu exista                                  88.Imi place sa fiu cu alti oameni

                                        (descrie):

                                                                                                         .

                                                                                                         .

      0      1      2                                                                                                 0      1      2    

                            89.Sunt suspicios                                                                                       106.Incerc sa fiu corect cu altii

      0      1      2                                                                                                 0      1      2    

                            90.Injur sau vorbesc murdar                                                107.Imi place o gluma buna

      0      1      2                                                                                                 0      1      2    

                            91.Ma gandesc sa ma omor                                                                       108.Imi place sa iau usor viata

      0      1      2                                                                                                 0      1      2    

                            92.Imi place sa-i fac pe altii sa rada                                           109.Incerc sa ajut alti oameni atunci

           cand pot

      0      1      2                                                                                                 0      1      2    

                            93.Vorbesc prea mult                                                                                   110.Mi-as fi dorit sa am sexul opus

      0      1      2                                                                                                 0      1      2    

                            94.Ii sicanez pe altii                                                                      111.Ma abtin sa ma implic cu altii

      0      1      2                                                                                                 0      1      2    

                            95.Am un temperament iute                                                       112.Ma ingrijorez frecvent

      0      1      2                                                                                                       

                            96.Ma gandesc prea mult la sex                                                              

      0      1      2                                                                                                       

                            97.Amenint oamenii cu lovirea                                               

      0      1      2                                                                                                       

                            98.Imi place sa-i ajut pe altii                                                     

      0      1      2                                                                                                       

                            99.Sunt prea preocupat sa fiu curat sau ingrijit                                                    

      0      1      2                                                                                                       

                            100.Am probleme cu somnul (descrie)                                     

                                                                                                         .

                                                                                                         .    

      0      1      2                                                                                                       

                             101.Chiulesc de la ore sau nu vin la scoala                                                          

      0      1      2                                                                                                       

                             102.Nu am multa energie                                                         

      0      1      2                                                                                                       

                              103.Sunt nefericit, trist sau deprimat                                                    

      0      1      2                                                                                                       

                              104.Sunt mai zgomotos decat alti copii                                                

      0      1      2                                                                                                       

                              105.Folosesc alcool sau medicamente                   

                                      pentru scopuri nemedicale (descrie):

                                                                                                         .

                                                                                                         .

                                                                                                                                                                                               .      

 

Te rugam sa scrii orice altceva care descrie sentimentele, comportamentul sau preocuparile tale        

                                                                                                                                                                                               .      

 

                                                                                                                                                                                               .      

 

                                                                                                                                                                                               .      

 

                                                                                                                                                                                               .      

 

                                                                                                                                                                                               .      

 

TE ROG SA TE ASIGURI CA AI RASPUNS LA TOATE INTREBARILE !

                       












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