The following questions are structured as if you were asking the student these questions. Feel free to change the wording so that it would fit an interview with a parent or teacher.

Home/Family:

1. Whom do you live with? (If there is a non-custodial parent, find out what the visitation schedule is.)
2. Family living outside the home?

Health:

3. Recent doctor visits?
4. Significant illnesses or injuries?
5. Medication? Now or in the past?
6. Vision and hearing?

Motor Skills:

7. Handwriting and fine-motor skills?
8. Participation in sports and gross motor skills?

Education/School:

9. Current school? Grade or level?
10. School history, including preschool?
11. Favorite classes or subjects?
12. Most difficult classes or subjects?
13. Do you get any extra help with these subjects? Who helps you? How do they help you?
14. Recent grades?
15. Experiences with homework? (How does the student experience homework? Is it difficult, easy, etc.? About how much homework does the student complete in a day or week? Try to get a percentage.)

Activities and Self: Interests, Skills, and Engagement in Productive Activities:

16. What are some things you like to do or think that you are good at?
17. How do you like to spend your free time? What are ways you have of relaxing and having fun? Hobbies, sports, music/movies?
18. How do you relax and have fun with your family (including common interests and activities)?

Coping:

19. How do you calm yourself down when upset or angry?
20. How do you handle difficult or stressful situations? Give an example of the last difficult situation you faced and how you handled it.

Social Support and Role Models:

21. What are your friends like (ages, gender)? What are some things you like to do together?
22. Whom are you closest to in your family?
23. When you get into trouble at home, how do your parents handle it?
24. Who in your life helps you reach your goals or explore your interests?
25. Name some people whom you respect or whom you see doing things you like or appreciate. What kinds of things do they do?

Required Helpfulness:

26. Who counts on you? (Follow up with: What do you do for them?)
27. Tell me about a time you did something nice for someone else, or you helped someone, or you gave him or her something they needed. What types of things do you enjoy doing for others?
28. How do you help out around the house?

Participation in Community:

29. Do you belong to any clubs, teams, community organizations, or churches (synagogues, temples, etc.)?

Goals and Aspirations:

30. If things went well for you over the next month, what would be different?
31. How do you see yourself in a year?
32. How about when you are an adult?

Transitions:

33. Did you recently change schools or are you planning to change schools?
34. Have you changed houses or are you planning to move soon?
35. Have there been any big changes in your family recently?

“Waking Day” Interview:

36. Think of a regular day for you. Tell me what you do first thing when you get up. What’s next? And after that? (Have the child describe what he or she does from waking up to going to bed at night.)

Screening for Social-Emotional Problems:

37. Have you been feeling sad or angry lately? (Depression)
38. Have you lost interest in or stopped enjoying the things that you usually like to do? (Depression)
39. Have you ever thought your life was not worth living or thought about hurting yourself in some way? (Depression)
40. How is your appetite? What kinds of things do you like to eat? Have you gained or lost weight lately? (Depression)
41. How do you sleep? About how much do you sleep each night? (Depression)
42. Do you often have trouble paying attention to details or keeping your mind on what you are doing? (ADHD)
43. Are you told to sit still a lot? (ADHD)
44. Do you usually get upset and lose your temper if things don’t go your way? (ODD)
45. Do you talk back or argue with your parents a lot? Your teachers? (ODD)
46. Do you worry more than other kids your age? If so, do you worry as often as every day or every other day? What do you worry about? (Anxiety)

Summary Sheet/Global Impressions:

47. Significant strengths or areas of typical functioning
48. Areas of significant need and risks
49. Suspected disabilities
50. Actions needed to enhance strengths and reduce risk