Assessment Measures 741IX. 14. Said that he/she heard voices—when there was no one there—
speaking about him/her or tellin g him/her what to do or say-
ing bad things to him/her?01 23 4
15. Said that he/she had a vision when he/she was completely awake—
that is, saw something or someone that no one else could see?01 23 4
X.16. Said that he/she had thoughts that kept coming into his/her 
mind that he/she would do so mething bad or that something 
bad would happen to him/her or to someone else?0 1 2 3 4
17. Said he/she felt the need to chec k on certain things over and over 
again, like whether a door was locked or whether the stove was 
turned off?0 1 2 3 4
18. Seemed to worry a lot about things he/she touched being dirty or 
having germs or being poisoned?0 1 2 3 4
19. Said that he/she had to do things  in a certain way, like counting 
or saying special things out lo ud, in order to keep something 
bad from happening?0 1 2 3 4
In the past TWO (2) WEEKS,  has your child…
XI. 20. Had an alcoholic beverage  (beer, wine, liquor, etc.)? ❑ Yes ❑ No ❑ Don’t Know
21. Smoked a cigarette, a cigar, or pipe, or used snuff or chewing 
tobacco?❑ Yes ❑ No ❑ Don’t Know
22. Used drugs like marijuana, cocaine or crack, club drugs (like 
ecstasy), hallucinogens (like LSD), heroin, inhalants or solvents