FBA Profiler Self Entry

FREE FBA Profiler On-Line Behavior/Mental Health Screeing

Please provide the following information.

When finished, click the "Submit Rating" button at the bottom of the page to view the report.

First Name:

 
Last Name:
 
Grade (if in school):

Age:

Sex:

malefemale

Do you have any of these diagnosed conditions?

noneadhdanxietydepressionOCDODDConductThought Disorder

Do you have any of these suspected (but not diagnosed) conditions?

noneadhdanxietydepressionOCDODDConductThought Disorder

Do you believe that you currently have serious emotional or behavioral difficulties which interfere in your life?

yesno

Ethnic Origin:

WhiteBlackAsianIndianHispanicMixed

State in which you live:

For the following items please select the rating that best describes the person being rated based on the scale to the right.

Note, there are 120 items, please complete them all for an accurate rating.

When finished click the "Submit Rating" button at the bottom of the page.

1
2
3
Not True
Somewhat True
Very True
1

I don't pay attention to details

123
2

I'm fidgety or squirmy

123
3

I'm easily embarrassed

123
4

I have delusions - believes things to be true which are not

123
5

I'm sad or depressed

123
6

I spread rumors about others

123
7

I'm physically cruel to animals

123
8

I can't get mind off of certain thoughts or mental images

123
9

I have difficulty organizing tasks or activities

123
10

I'm constantly moving or "on the go"

123
11

I'm e asily annoyed by others

123
12

I sleep too much during the day

123
13

I perform certain actions over and over to relieve stress

123
14

I'm angry or upset when ignored

123
15

I avoid talking or interacting with peers

123
16

I try to get others in trouble

123
17

I get headaches

123
18

I'm reluctant to engage in tasks which require sustained attention or effort

123
19

I talk too much

123
20

I'm angry and/or resentful

123
21

I follow negative peer influence

123
22

I have a strong preference for being alone or isolated rather than with others

123
23

I perceive criticism or teasing when it was not intended

123
24

I seek attention from others

123
25

I lose things which are necessary to complete tasks (such as pencils, paper, books, etc.)

123
26

I blurt out answers even before a question has been competed

123
27

I'm vindictive - want to "get back at" someone

123
28

I have slow or delayed body movements

123
29

I do not participate in sports, clubs, or other group activities

123
30

I'm distracted by noises or activities

123
31

I have difficulty waiting for your turn

123
32

I'm tired or lacking energy

123
33

I'm generally anxious or nervous

123
34

I do not follow or obey rules

123
35

I'm forgetful

123
36

I interrupt others

123
37

I feel guilty or worthless

123
38

I get angry when teased

123
39

I have difficulty concentrating or making decisions

123
40

I vandalize property

123
41

I have thoughts of suicide or death

123
42

I'm shy

123
43

I bully , threaten, or intimidate others

123
44

I start fires with intent to cause damage

123
45

I have broken into someone's house, building, locker, car, etc.

123
46

I stay out at night beyond curfew

123
47

I make careless mistakes

123
48

I leave seat in classroom or other situations when expected to be seated

123
49

I have verbal arguments with adults

123
50

I have hallucinations - hearing or seeing things which others do not

123
51

I lack interest in or pleasure for most daily activities

123
52

I tend to overreact to criticism or embarrassment

123
53

I get stomachaches

123
54

I bite or pick at fingernails, hair, or skin

123
55

I have frequent excused absences from school

123
56

I withraw or "shut down" when embarrassed

123
57

I get angry when embarrassed

123
58

I get nervous when speaking or performing in front of others

123
59

I start fights with others

123
60

I deliberately destroy the property of others

123
61

I lie to or otherwise manipulates others to gain favors or avoid obligations

123
62

I run away from home

123
63

I have difficulty staying focused on tasks or activities

123
64

I lose my temper

123
65

I skip class or school

123
66

I use tobacco, alcohol, or other "street drugs"

123
67

I run about or climbs on things inappropriately

123
68

I have disorganized speech - difficult for others to follow or understand

123
69

I've experienced significant weight change (gain or loss)

123
70

I'm perfectionistic

123
71

I complain of body aches or pains

123
72

I tease others

123
73

I do not complete schoolwork

123
74

I'm a negative leader among peers

123
75

I get angry when criticized

123
76

I swear or uses obscene language

123
77

I have used a weapon which could cause serious harm to others (like a knife, gun, bat, etc.)

123
78

I have stolen from home, school or elsewhere (like shoplifting)

123
79

I have frequent unexcused absences from school

123
80

I do not seem to listen when spoken to

123
81

I'm restless

123
82

I deliberately annoy others

123
83

I have very disorganized or unpredictable behavior without an apparent purpose

123
84

I frequently visit the doctor or school nurse

123
85

I'm irritable

123
86

I have verbal arguments with peers

123
87

I complain of eye problems (not related to a need for glasses)

123
88

I make disruptive noises

123
89

I do not complete chores

123
90

I resent authority

123
91

I use behavior to conceal frustration

123
92

I have a high need for social acceptance

123
93

I'm physically cruelty to other people

123
94

I do not follow instructions or finish assigned tasks

123
95

I have difficulty quietly engaging in leisure activities

123
96

I write threatening letters or notes

123
97

I display very little emotion or "affect"

123
98

I compain of difficulty sleeping at night

123
99

I'm tense

123
100

I seem to have a compulsive need to repeat certain behaviors (i.e. hand washing, counting steps, saying a series of words silently or aloud, et.)

123
101

I have skin problems (rashes, etc.)

123
102

I like to be the "center of attention"

123
103

I'm often difficult to find -I hide or disappear

123
104

I don't like being told what to do

123
105

I get more upset if punished or criticized in front of others

123
106

I like to be "in charge"

123
107

I engage is a certain impulsive reaction over and over

123
108

I hold a grudge

123
109

I'm inflexible - need to always do things in a certain way

123
110

I blame others for my mistakes or misbehavior

123
111

I'm unable to make or keep friends

123
112

I have considerable difficulty relating to other people

123
113

I misinterpret social cues or the behavior of others

123
114

I have difficulty using or understanding nonverbal communication (such as gestures, facial expressions, tone of voice, etc.)

123
115

I have very unusual speech patterns (such as tone, rhythm, or rate)

123
116

I have considerable difficulty initiating or maintaining a conversation

123
117

I insist on following certain rules, routines, or rituals

123
118

I'm very resistant to changes in activity

123
119

I'm overly preoccupied with a specific area of interest

123
120

I'm highly sensitive to certain sensory stimuli (such as light, sound, texture, smell, etc.)

123
 
Participation Code (if you have one):
If you don't know what this is, leave it blank