Children's Adjustment Inventory

Getting Started


On the line to the right of the problem number, put a 3,
2, 1, or 0. A 3 means that the problem has been observed during the reporting
period and parents and others are VERY CONCERNED about it. A 2 means the
problem has been observed during the reporting period and parents and others
are SOMEWHAT CONCERNED about it. A 1 means the problem has been observed during
the reporting period but parents and others are NOT VERY CONCERNED about it. A
0 means that parents and others have not observed the problem during the
reporting period; and no one has told you about the child's having the problem.
(Generally, it is appropriate to use the preceding month as the reporting
period.)



 



After
completing the inventory, focus your analysis first on those items scored at
the “3" or “2" levels. Combining that with focus on the categories as
indicated will assist in isolating the child’s difficulties and in developing
an issue oriented intervention plan. A child who receives no “3" or
“2" ratings is unlikely to have serious adjustment difficulties but you
should be alert to possible patterns of mild behavior difficulty and to slowly name=QuickMark>developing problems.



 



The
child:



(Signs
of stress)



style='mso-spacerun: yes'> 1.        ____style='mso-tab-count:1'>    Is restless and has trouble calming down.



 



style='mso-spacerun: yes'> 2.        ____style='mso-tab-count:1'>    Has trouble concentrating and paying
attention.



 



style='mso-spacerun: yes'> 3.        ____style='mso-tab-count:1'>    Has problems going to sleep. (Might wake up
during the night.)



 



style='mso-spacerun: yes'> 4.        ____style='mso-tab-count:1'>    Has bad dreams. (Also might have
nightmares.)



 



style='mso-spacerun: yes'> 5.        ____style='mso-tab-count:1'>    Has headaches.



 



style='mso-spacerun: yes'> 6.        ____style='mso-tab-count:1'>    Has problems with an upset stomach.



 



style='mso-spacerun: yes'> 7.        ____style='mso-tab-count:1'>    Cries very easily. (Also might have crying
spells.)



 



style='mso-spacerun: yes'> 8.        ____style='mso-tab-count:1'>    Loses his/her temper easily and quickly.



 



(Signs
of low self-esteem)



style='mso-spacerun: yes'> 9.        ____style='mso-tab-count:1'>    Worries and frets about not doing things
well enough and about failing.



 



10.
____          Does not start things
because he/she is afraid they will turn out badly anyway.



 



11.
____          Gives up quickly and easily.



 



12.
____          Does not feel good about
his/her physical and sexual development.



 



13.
____          Does not like him/herself.
(Also might put him/herself down.)



 



14.
____          Does not feel he/she fits in
or belongs anywhere.



 



15.
____          Does not feel loved by
anyone.



 



16.
____          Does not feel like someone
anyone can love.



 



(Signs
of suicidal thoughts and feelings)



17.style='mso-tab-count:1'>       ____    Lost
an important relationship and can hardly live without it.



 



18.style='mso-tab-count:1'>       ____    Became
very embarrassed over something and cannot face it.



 



19.
____          Is not getting over a
serious loss or disappointment.



 



20.
____          Can hardly handle having
lost a physical ability or skill.



 



21.
____          Feels unable to do anything
about what happens to him/her.



 



22.
____          Thinks about suicide.



 



23.
____          Attempted suicide.



 



(Signs
of emotional and mental illness)



24.
____          Has extreme mood swings.
(His/her mood jumps from one extreme to the other and he/she cannot control
it.)



 



25.
____          Goes on extreme eating
binges. (Might be unusually overweight.)



 



26.
____          Vomits after eating or uses
laxatives to control his/her weight.



 



27.
____          Starves him/herself.



 



28.
____          Does not trust anyone and
thinks people are out to get him/her.



 



29.
____          Has very strange thoughts
and feelings he/she cannot understand or control.



 



30.
____          Has extreme fears that keep
him/her from doing things most people the same age do easily.



 



31.
____          Refuses to keep clean and
take care of his/her personal needs.



 



32.
____          Cannot stand having people
close or touching him/her.



 



33.
____          Urinates or defecates in
his/her clothes.



 



34.
____          Cuts or hurts him/herself on
purpose.



 



35.
____          Is interested in fire,
watching fires, setting fires, and doing things with fire.



 



36.
____          Hears voices and sees things
others do not hear and cannot see.



 



(Signs
of school and learning problems)



37.
____          Has trouble making choices
and decisions.



 



38.
____          Cannot express his/her
thoughts and ideas.



 



39.
____          Cannot do things others
his/her age can do.



 



40.
____          Does not understand
assignments and what people expect.



 



41.
____          Does not understand what
he/she reads.



 



42.
____          Gets confused.



 



43.
____          Trying harder does not lead
to his/her work and skills getting better.



 



44.
____          Does some assignments very
well and others very badly.



 



45.
____          Forgets what to do or what
people expected.



 



46.
____          Does not follow instructions
and directions.



 



47.
____          Does not pay attention to
time. (Also might not manage time very well.)



 



48.
____          Gets bad grades.



 



49.
____          Does not ask for help or let
others help.



 



50.
____          Has trouble accepting or
dealing with criticism.



 



51.
____          Has excuses for not doing
well.



 



52.
____          Thinks his/her not doing
well is someone else's fault.



 



53.
____          Has to have an adult
standing over him/her to be sure his/her work gets done.



 



54.
____          Feels teachers have it in
for him/her.



 



55.
____          Disrupts the class or the
activities of others.



 



56.
____          Does not make any effort to
cooperate and get along.



 



57.
____          Misses school.



 



(Signs
of relationship problems)



58.
____          Pouts and is hard to live
with.



 



59.
____          Is hateful and in a bad
mood.



 



60.
____          Gets very angry when things
do not go his/her way.



 



61.
____          Screams and yells at people.



 



62.
____          Breaks or damages things.



 



63.
____          Hits or hurts people.



 



64.
____          Starts or gets into fights.



 



65.
____          Bullies and picks on others.



 



66.
____          Is cruel to others.



 



67.
____          Lost interest in people and
activities he/she had enjoyed.



 



68.
____          Has trouble making and
keeping friends.



 



69.
____          Avoids people and stays away
from social activities.



 



70.style='mso-tab-count:1'>       ____    Prefers
activities he/she can do alone.



 



71.
____          Does not talk to anyone
about his/her feelings and thoughts.



 



72.
____          Wants to keep his/her
friends all to him/herself.



 



73.
____          Gets his/her feelings hurt.



 



74.
____          Is the brunt of teasing and
put‑downs.



 



75.
____          Gets up‑tight and
nervous when someone is angry or upset.



 



76.
____          Does not stick up for
him/herself.



 



77.
____          Tries to please everyone and
keep everyone happy.



 



78.
____          Feels most people do not
like him/her.



 



79.style='mso-tab-count:1'>       ____    People
his/her age do not like him/her.



 



(Signs
of value difficulty)



80.
____          Does not follow the rules or
behave as most others do.



 



81.
____          Does not accept the
authority of parents, teachers, or others in charge.



 



82.
____          Behaves in socially
inappropriate ways.



 



83.
____          Uses illegal drugs.



 



84.
____          Thinks rules and laws are
for someone else.



 



85.
____          Has friends who get into
trouble.



 



86.
____          Is not someone others depend
on or trust.



 



87.
____          Does not care if he/she
upsets or hurts people.



 



88.
____          Gets into trouble with the
police or courts.



 



Instead
of whether you have observed the problem, respond to the next signs with
whether the child has EVER experienced them. On the blank next to the number,
use 3, 2, or 1 to show how much the problem affected the youngster. 3 = an
extreme effect, 2 = a moderate effect, and 1 = a mild to no effect. N = never
experienced.



 



(Signs
of abuse and abusive families)



89.
____          Parents did not care what
he/she thought and felt.



 



90.
____          Parents did not know what
he/she needed and what was important to him/her. (Knowing but not doing
anything is included here.)



 



91.
____          He/she could not live up to
what others expected.



 



92.
____          Parents did not know about
or help with his/her problems and difficulties. (Knowing but not doing anything
is included here.)



 



93.
____          People in his/her family
fought and argued.



 



94.
____          People in his/her family
were violent and hurt each other.



 



95.
____          Members of his/her family
abused alcohol or other drugs.



 



96.
____          Members of his/her family
did illegal or immoral things.



 



97.
____          Parents (or someone else)
were abusing him/her sexually, physically, or in other ways.



 



98.style='mso-tab-count:1'>       ____    Had
sex with much younger or older people.



 



99.
____          Wanted to escape from or get
away from his/her home or from members of his/her family.



 



100.
____        Cannot be permitted to live
with his/her family. (May be due to his/her problems or those of the family.)



By Gary A. Crow, Ph.D. March 23, 2017