After completing the questionnaire refer to the scoring guide which
will offer suggestions, and recommendations based on the results of
your own responses.
Note: Answer Yes or No to each question. If the answer is yes check
the box to the right.
Yes
1. Does your teen struggle with basic
family rules and expectations?
2. Has your teen ever been suspended,
expelled, truant, or had a drop in school grades?
3. Is your teen verbally abusive?
4. Does your teen associate with a bad
peer group?
5. Has your teen lost interest in former
productive activities, hobbies or sports?
6. Do you have difficulty getting your
teen to do simple household chores or homework?
7. Has your teen had problems with the
law?
8. Do you find yourself picking your words
carefully when speaking to your teen, so as not to elicit a verbal
attack or rage from them?
9. Are you worried that your teen may
not finish high school?
10 .Does your teen seem depressed/withdrawn?
11. Has your teen's appearance and/or
personal hygiene changed?
12. Does your teen ever display violent
behavior?
13. Is your teen manipulative and/or deceitful?
14. Does your teen seem to demonstrate
a lack of motivation?
15. Do you suspect that your teen sometimes
lies or is dishonest with you?
16. Are you concerned that your teen may
be sexually promiscuous?
17. Has your teen ever displayed any evidence
of suicide ideation?
18. Do you suspect at times you have had
money or other valuables from your home?
19. Does your teen's behavior concern
you for their safety?
20. Is your teen angry or display temper
outbursts?
21. Does your teen seem to lack self-esteem
and self-worth?
22. Do you have a lack of trust with your
teen?
23. Does your teen have problems with
authority?
24. Does your teen engage in activities
you don't approve of?
25. Do you think your teen is possibly
using or experimenting with drugs/alcohol?
26. Are you concerned about your child's
well being and their future?
27. Does your teen seem to constantly
be in opposition to your family values?
28. No matter what rules and consequences
are established, do you feel that your teen will defy them?
29. Are you exhausted and worn out from
your teen's defiant and/or destructive behavior and choices?
30. When dealing with your teen, do you
often feel that you are powerless?
Questionnaire Score Card
18+High Risk! Get help! A Residential
Center, Treatment Program, or Specialty School is strongly recommended.
9-17Borderline Risk! The problems may
be resolved by tightening up family rules and structure. However,
a Residential Center, Treatment Program, or Specialty School may need
to be considered.
1-8Moderate Risk! Tighten up family
rules/understandings, be consistent with your monitoring, and follow
through.
For more information Call Toll Free 1-866-842-9587
"Its Easier To Build Strong Children, Than To Repair Broken Adults"