Checklist of Behaviors and Disorders

Behaviors and disabilities	Not at all	Mild	Moderate	Severe
AIDS or HIV positive
Alcohol or drug use
Anemia
Aspbergers Syndrome
Asthma or Wheezing
Attention Deficit Disorder
Autism
Bed wetting- Not age appropriate
Blindness
Blood problems
Cerebral Palsy
Chronic run away
Cruelty to Animals
Deafness
Depression
Destructive
Development Delays
Diabets
Down Syndrome
Dyslexia
Eating disorders
Emotional Disturbance
Epilepsy
Feeding tube
Fetal alcohol effects/syndrome
Fire setting
Food hoarding
Heart disorders
Heart monitor
Homosexuality
Learning disabilities
Mental Retardation
Missing limb
Muscular Dystrophy
Needs help with toilet
Neurological Impairment
Physically aggressive
Pre-natal drug exposure
Self injury
Sexual abuse
Sexually active
Sleeping disorders
Stealing
Suicide attempts
Temper Tantrums
Tourette's Syndrome
Tuberculosis
Ventilator