FBA Profiler Self Entry

First Name:

Age:

Sex:

Do you have any of these diagnosed conditions?

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

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

Ethnic Origin:

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.

I don't pay attention to details

I'm fidgety or squirmy

I'm easily embarrassed

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

I'm sad or depressed

I spread rumors about others

I'm physically cruel to animals

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

I have difficulty organizing tasks or activities

I'm constantly moving or "on the go"

I'm e asily annoyed by others

I sleep too much during the day

I perform certain actions over and over to relieve stress

I'm angry or upset when ignored

I avoid talking or interacting with peers

I try to get others in trouble

I get headaches

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

I talk too much

I'm angry and/or resentful

I follow negative peer influence

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

I perceive criticism or teasing when it was not intended

I seek attention from others

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

I blurt out answers even before a question has been competed

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

I have slow or delayed body movements

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

I'm distracted by noises or activities

I have difficulty waiting for your turn

I'm tired or lacking energy

I'm generally anxious or nervous

I do not follow or obey rules

I'm forgetful

I interrupt others

I feel guilty or worthless

I get angry when teased

I have difficulty concentrating or making decisions

I vandalize property

I have thoughts of suicide or death

I'm shy

I bully , threaten, or intimidate others

I start fires with intent to cause damage

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

I stay out at night beyond curfew

I make careless mistakes

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

I have verbal arguments with adults

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

I lack interest in or pleasure for most daily activities

I tend to overreact to criticism or embarrassment

I get stomachaches

I bite or pick at fingernails, hair, or skin

I have frequent excused absences from school

I withraw or "shut down" when embarrassed

I get angry when embarrassed

I get nervous when speaking or performing in front of others

I start fights with others

I deliberately destroy the property of others

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

I run away from home

I have difficulty staying focused on tasks or activities

I lose my temper

I skip class or school

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

I run about or climbs on things inappropriately

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

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

I'm perfectionistic

I complain of body aches or pains

I tease others

I do not complete schoolwork

I'm a negative leader among peers

I get angry when criticized

I swear or uses obscene language

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

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

I have frequent unexcused absences from school

I do not seem to listen when spoken to

I'm restless

I deliberately annoy others

I have very disorganized or unpredictable behavior without an apparent purpose

I frequently visit the doctor or school nurse

I'm irritable

I have verbal arguments with peers

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

I make disruptive noises

I do not complete chores

I resent authority

I use behavior to conceal frustration

I have a high need for social acceptance

I'm physically cruelty to other people

I do not follow instructions or finish assigned tasks

I have difficulty quietly engaging in leisure activities

I write threatening letters or notes

I display very little emotion or "affect"

I compain of difficulty sleeping at night

I'm tense

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.)

I have skin problems (rashes, etc.)

I like to be the "center of attention"

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

I don't like being told what to do

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

I like to be "in charge"

I engage is a certain impulsive reaction over and over

I hold a grudge

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

I blame others for my mistakes or misbehavior

I'm unable to make or keep friends

I have considerable difficulty relating to other people

I misinterpret social cues or the behavior of others

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

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

I have considerable difficulty initiating or maintaining a conversation

I insist on following certain rules, routines, or rituals

I'm very resistant to changes in activity

I'm overly preoccupied with a specific area of interest

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