Questionnaire for Assessing the Mental State of a Child (2-6 years)

Instructions: Please check the items that correspond to the child's behavior or condition observed recently.

1. Irritability, aggression

2. Whimsicality, tearfulness, disobedience, rule-breaking

3. Passivity, helplessness

4. Unmotivated anxiety

5. Difficulty concentrating, attention problems not previously characteristic of the child

6. Anxious attachment (unwillingness to let go of a close adult..., fear when an adult leaves home)

7. Refusal to speak (mutism), stuttering, monotonous speech, unusual changes in speech volume

8. Compulsive actions, rituals, repetitive questions about safety ("will everything be okay?", "are we going to die?", etc.)

9. Refusal to play, interact with children

10. Regressive behavior (behavior characteristic of a younger age – thumb sucking, enuresis, encopresis, babbling, speech disorders)

11. Somatic manifestations: nausea, sweating, tremors, stool disorders, headaches, dizziness, enuresis, encopresis, tics

12. Physical manifestations: freezing, startling, stiffness of posture and movements, slowness of movements, sad or frightened facial expression, mask-like face, motor stereotypies (rocking, etc.)

13. Sleep disturbances (frequent awakenings, nightmares, night terrors, hypersomnia (excessively long sleep), fear of falling asleep)

14. Appetite disturbances (increased, refusal to eat, nausea with meals)

Child's State Assessment Results:

Total score: 0

Interpretation:

Recommended course of action:

Mental Health Support

Please seek professional help if the result indicates a risk or if you are experiencing difficulties. Contact a local emergency service or a mental health helpline for parents and children.

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