Client History - Adolescent (Part 2)

Developmental History

Adopted:

Yes

If yes, what age?

Pregnancy: (labor, delivery, pregnancy or labor complications)

1st to 2nd Year: (breast or bottle, activity level, thumb of pacifier user, favorite toys, stranger anxiety, sleep and eating patterns)

Toilet training: (temper tantrums, discipline, expression of frustration or anger)

Preschool or Day Care: (age, separation from parents, teacher reports, peer play)

Favorite toys and activities:

Hobbies, athletics, drama, art, extracurricular activities:

School History (please discuss friendship patterns, parental relationships, academic performances, attention and concentration, psychomotor development for each section below)

1st Grade:

3rd Grade:

6th Grade and Middle School Years:

High School:

Overall Study Habits:

Please continue to Part 3: Social Habits.