ABHS COVID-19 RESPONSE INFORMATION

CMRS, Parent Version

Child's Name

First Name

Last Name

Instructions

The following questions concern your child’s mood and behavior in the past month. Please place a check mark or an ‘x’ in a box for each item. Please consider it a problem if it is causing trouble and is beyond what is normal for your child's age. Otherwise, check 'rare or never' if the behavior is not causing trouble. 0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

1. Have periods of feeling super happy for hours or days at a time, extremely wound up and excited, such as feeling "on top of the world"

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

2. Feel irritable, cranky, or mad for hours or days at a time

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

3. Think that he or she can be anything or do anything (e.g., leader, best basket ball player, rap singer, millionaire, princess) beyond what is usual for that age

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

4. Believe that he or she has unrealistic abilities or powers that are unusual, and may try to act upon them, which causes trouble

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

5. Need less sleep than usual; yet does not feel tired the next day

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

6. Have periods of too much energy

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

7. Have periods when she or he talks too much or too loud or talks a mile-a-minute

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

8. Have periods of racing thoughts that his or her mind cannot slow down , and it seems that your child’s mouth cannot keep up with his or her mind

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

9. Talk so fast that he or she jumps from topic to topic

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

10. Rush around doing things nonstop

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

11. Have trouble staying on track and is easily drawn to what is happening around him or her

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

12. Do many more things than usual, or is unusually productive or highly creative

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

13. Behave in a sexually inappropriate way (e.g., talks dirty, exposing, playing with private parts, masturbating, making sex phone calls, humping on dogs, playing sex games, touches others sexually)

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

14. Go and talk to strangers inappropriately, is more socially outgoing than usual

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

15. Do things that are unusual for him or her that are foolish or risky (e.g., jumping off heights, ordering CDs with your credit cards, giving things away)

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

16. Have rage attacks, intense and prolonged temper tantrums

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

17. Crack jokes or pun more than usual, laugh loud, or act silly in a way that is out of the ordinary

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

18. Experience rapid mood swings

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

19. Have any suspicious or strange thoughts

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

20. Hear voices that nobody else can hear

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

21. See things that nobody else can see

0 = Never/Rarely, 1 = Sometimes. 2 = Often. 3 = Very Often

New Form

Child's Name

First Name

Last Name

Directions:

Each rating should be considered in the context of what is appropriate for the age of your child. When completing this form, please think about your child’s behaviors in the past 6 months.

Is this evaluation based on a time when the child

was on medication

was not on medication

not sure?

1. Does not pay attention to details or makes careless mistakes with, for example, homework