Bipolar Disorder Parent Screener Child's First Name *Child's Last Name *Parent/Guardian Name *Date of Birth *Date of Screening *Email Address *Phone * Recommended age: 8-17 Instructions: Please rate how often you notice these mood or behavior patterns in your child/teen: 0 = Never 1 = Sometimes 2 = Often Q1. Has periods of unusually high energy or extreme happiness for several days *NeverSometimesOftenQ2. Sleeps much less during these times, and seems unusually confident or risky *NeverSometimesOftenQ3. Acts impulsively in ways that could cause problems (spending, dangerous behaviors, aggression) *NeverSometimesOftenQ4. Also has periods of sadness, irritability, or hopelessness lasting days or weeks *NeverSometimesOftenQ5. These mood swings cause problems in school, friendships, or family life *NeverSometimesOftenTotal ScoreSubmit
