PROBLEM BEHAVIOR RATING SCALE – Parent

Child’s Name:_______________________ Age: ______ Birth Date:_____________

Person completing form:__________________________ Date:________________

A. Please use the following scale to indicate which of the following behaviors are
problematic for your child:

1 2 3 4
Not at all Very
problematic problematic

1. Acting impulsively or carelessly, without regard for consequences 1 2 3 4

2. Hitting or hurting others 1 2 3 4
3. Teasing or bullying others 1 2 3 4
4. Damaging or breaking things that belong to others 1 2 3 4
5. Screaming or yelling 1 2 3 4
6. Having sudden mood changes; demonstrating mood swings 1 2 3 4
7. Having temper tantrums or meltdowns 1 2 3 4
8. Being overly bossy or stubborn; needing to have his/her own way 1 2 3 4
9. Having a low frustration tolerance; becoming easily angered or upset 1 2 3 4
10. Crying easily with minor provocation 1 2 3 4
11. Making negative statements about him/herself 1 2 3 4
12. Being overly quiet, shy, or withdrawn 1 2 3 4
13. Acting sulky or sad 1 2 3 4
14. Being underactive or lacking in energy; sedentary 1 2 3 4
15. Expressing worry about many things 1 2 3 4
16. Engaging in behaviors that may be distasteful to others, such as 1 2 3 4
nose-picking or spitting
17. Touching him/herself inappropriately 1 2 3 4
18. Engaging in compulsive behaviors; repeating certain acts over and over; 1 2 3 4
having to do the same behavior in a specified way many times
19. Being overly concerned with making mistakes; being a perfectionist 1 2 3 4
20. Having toileting accidents 1 2 3 4
21. Hitting or hurting him/herself 1 2 3 4
22. Becoming overly upset when others touch or move his/her belongings 1 2 3 4
23. Laughing or giggling at inappropriate times (e.g., when others are hurt 1 2 3 4
or upset)
24. Ignoring or walking away from others during interactions or play 1 2 3 4
25. Becoming upset if routines are changed 1 2 3 4
26. Touching others inappropriately 1 2 3 4
27. Asking the same questions over and over 1 2 3 4
28. Engaging in unusual mannerisms such as hand-flapping or spinning 1 2 3 4
29. Having to play or do things in the same exact way each time 1 2 3 4
30. Having difficulty calming him/herself down when upset or excited 1 2 3 4

B. Please star the behaviors above that interfere with your child’s ability to make
and keep friends.

© 1998, 2010 Vanderbilt TRIAD 33

 PROBLEM BEHAVIOR RATING SCALE – Teacher

Child’s Name:____________________________ Age: ______ Birth Date:_____________

Teacher completing form:______________________________ Date:________________

How long teacher has known child: _____________________________________________

A. Please use the following scale to indicate which of the following behaviors are
problematic for this child:

1 2 3 4
Not at all Very
problematic problematic

1. Acting impulsively or carelessly, without regard for consequences 1 2 3 4

2. Hitting or hurting others 1 2 3 4
3. Teasing or bullying others 1 2 3 4
4. Damaging or breaking things that belong to others 1 2 3 4
5. Screaming or yelling 1 2 3 4
6. Having sudden mood changes; demonstrating mood swings 1 2 3 4
7. Having temper tantrums or meltdowns 1 2 3 4
8. Being overly bossy or stubborn; needing to have his/her own way 1 2 3 4
9. Having a low frustration tolerance; becoming easily angered or upset 1 2 3 4
10. Crying easily with minor provocation 1 2 3 4
11. Making negative statements about him/herself 1 2 3 4
12. Being overly quiet, shy, or withdrawn 1 2 3 4
13. Acting sulky or sad 1 2 3 4
14. Being underactive or lacking in energy; sedentary 1 2 3 4
15. Expressing worry about many things 1 2 3 4
16. Engaging in behaviors that may be distasteful to others, such as 1 2 3 4
nose-picking or spitting
17. Touching him/herself inappropriately 1 2 3 4
18. Engaging in compulsive behaviors; repeating certain acts over and over; 1 2 3 4
having to do the same behavior in a specified way many times
19. Being overly concerned with making mistakes; being a perfectionist 1 2 3 4
20. Having toileting accidents 1 2 3 4
21. Hitting or hurting him/herself 1 2 3 4
22. Becoming overly upset when others touch or move his/her belongings 1 2 3 4
23. Laughing or giggling at inappropriate times (e.g., when others are hurt 1 2 3 4
or upset)
24. Ignoring or walking away from others during interactions or play 1 2 3 4
25. Becoming upset if routines are changed 1 2 3 4
26. Touching others inappropriately 1 2 3 4
27. Asking the same questions over and over 1 2 3 4
28. Engaging in unusual mannerisms such as hand-flapping or spinning 1 2 3 4
29. Having to play or do things in the same exact way each time 1 2 3 4
30. Having difficulty calming him/herself down when upset or excited 1 2 3 4

B. Please star the behaviors above that interfere with this child’s interactions with
others.

©1998, 2010 Vanderbilt TRIAD 41

 Parent Teacher
Behavior
Report Report
Acting impulsively or carelessly without regard for consequences
Hitting or hurting others X
Teasing or bullying others X
Damaging or breaking things that belong to others
Screaming or yelling X
Having sudden mood changes, demonstrating mood swings X X
Having temper tantrums X
Being overly bossy or stubborn own way X
Having a low frustration tolerance X
Crying easily with minor provocation
Making negative statements about him/herself
Being overly quiet, shy or withdrawn X
Acting sulky or sad
Being underactive or lacking in energy, sedentary
Expressing worry about many things
Engaging in behaviors that may be distasteful to others, such as nose X (verbal)
picking
Touching him/herself inappropriately
Engaging in compulsive behaviors; repeating certain acts over and
over; having to do the same behavior in a specified way many times
Being overly concerned with making mistakes; being perfectionist
Having toileting accidents
Hitting or hurting him/herself
Becoming overly upset when others touch or move his/her belongings
Laughing or giggling at inappropriate times
Ignoring or walking away from others during interactions or play
Becoming upset if routines are changed
Touching others inappropriately X
Asking the same questions over and over X

Engaging in unusual mannerisms such as hand-flapping or spinning

Having to play or do things in the same exact way each time X
Having difficulty calming him/herself down when upset or excited X

© 1998, 2010 Vanderbilt TRIAD 25