5-15R

QUESTIONNAIRE FOR EVALUATION

OF DEVELOPMENT AND BEHAVIOUR
Parent questionnaire

To the parents: This questionnaire, for children and adolescents age 5 to 17, contains statements concerning the
skills and behaviours of your child in various domains of development. Children are individuals. This means that their
skills and behaviours vary from one child to another, and according to age.

The statements in the questionnaire are followed by boxes marked Does not apply – Applies sometimes/to some
extent – Applies. Tick the box that contains the statement that you think best corresponds to your child’s
functioning in everyday situations, compared to children of their own age. Have in mind the child’s present functioning,
i.e. within the last 6 months. To get the most correct picture of your child’s functioning, it is important that you
complete the whole questionnaire.

You will be asked if the child’s functioning in various domains leads to problems in daily living. Please consider whether
or not these problems affect the child and others at home, in school and among friends. These questions are followed
by four options: No – A little – A great deal – Very much.

Your child’s name: ....................................................................... Form completed by: ..................................................................

Date of birth: ....................................................................... Date: ..................................................................

To the professional applying this questionnaire: The questionnaire aims at elucidating the parent’s views on their child’s
strengths and weaknesses in several developmental domains. It is not meant to serve as the sole basis for diagnostic
decisions. The use of this questionnaire requires knowledge about normal and atypical child development as well as
basic knowledge in psychometrics. Guidelines for professional use, administration and scoring are found in the
MANUAL.

A teacher edition of the questionnaire is also available.

Reference for this questionnaire: Kadesjö, B., Janols. L-O, Korkman, M., Mickelsson, K., Strand, G., Trillingsgaard, A., Lambek, R.,
Øgrim, G., Bredesen, A., & Gillberg, C. (2017). Five-To-Fifteen-Revised (5-15R). Available at www.5-15.org

Copyright ©: (2004): Björn Kadesjö, Göteborg, Lars-Olof Janols, Uppsala, Marit Korkman, Helsingfors, Katarina Mickelsson,
Helsingfors, Gerd Strand, Oslo, Anegen Trillingsgaard, Århus, Christopher Gillberg, Göteborg
The Copyright is protected under the Swedish Copyright Act – the Swedish law Act on Copyright in Literary and Artistic Works
(1960:729).

Copying for own use is allowed.

File name: 515_en-GB.pdf

File version: 2017.p.1.4
File date: 2017-06-13
 Does not Applies Applies
apply sometimes/
to some
extent

Motor skills - gross motor skills; the child´s use of his/her body in various activities
1. Difficulty acquiring new motor skills, such as learning how to ride a bike, skate,
swim   
2. Difficulty throwing and catching a ball   
3. Difficulty running fast   
4. Has difficulties or does not like to participate in game sports such as
soccer/football, land hockey, basketball   
5. Balance problems; for instance, has difficulty standing on one leg   
6. Often stumbles and falls   
7. Clumsy or awkward movements   
Motor skills - fine motor skills; the child’s use of his/her hands:
8. Does not like to draw, has difficulties drawing figures that represent something   
9. Difficulty handling, assembling and manipulating small objects   
10. Difficulty pouring water into a glass without spilling   
11. Often spills food onto clothes or table when eating   
12. Difficulty using knife and fork   
13. Difficulty buttoning or tying shoe-laces   
14. Difficulty using a pen (e.g., presses too hard, hand is shaking)   
15. Has not developed clear hand preference, i.e., is neither clearly right-handed nor
left-handed   
16. Writing is slow and laborious   
17. Immature pencil-grip, holds the pen in an unusual manner   
Do problems with motor function interfere with your child’s daily function?
Not at all  A little  Pretty much  Very much 

Attention and concentration: the child’s ability to pay attention and to concentrate on various tasks and
activities:
18. Often fails to pay close attention to details or makes careless mistakes   
19. Often has difficulty sustaining attention in tasks or play activities   
20. Often does not seem to listen when spoken to directly   
21. Problems following instructions and fails to finish schoolwork, chores, or duties   
22. Often has difficulty organizing tasks and activities   
23. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort (such as homework)   
24. Often loses things necessary for tasks or activities (e.g., toys, school equipment,
pencils, books, or tools)   
25. Is often easily distracted by extraneous stimuli (e.g., irrelevant sounds like other
people talking, cars driving by)   
26. Is often forgetful in daily activities   
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 Does not Applies Applies
apply sometimes/
to some
extent

Overactivity and impulsivity; the child’s tendency to be too active or impulsive:

27. In constant motion (fidgets with fingers, plucks at things etc)   
28. Difficulty remaining seated (squirms in seat, gets up and moves about)   
29. Often runs about or climbs excessively in situations in which is inappropriate   
30. Difficulty playing calmly and quietly   
31. Is often ”on the go” or often acts as if ”driven by a motor”   
32. Often talks excessively   
33. Often blurts out answers before the question has been completed   
34. Difficulty awaiting turns (in games, during meals etc)   
35. Often interrupts or intrudes on others (e.g., butts into conversations or games)   
Do problems with attention, concentration, over-activity or impulsivity interfere with your child’s daily function?
Not at all  A little  Pretty much  Very much 

Passivity/inactivity: the child’s inactivity or tendency to be too passive

36. Difficulty getting started on tasks/activities   
37. Difficulty completing a task/activity, does not get things done like the rest of the
group   
38. Often ”in own world” or daydreaming   
39. Seems slow, inert, or lacking energy   
Does passivity or inactivity interfere with your child’s daily function?
Not at all  A little  Pretty much  Very much 

Planning/organizing; the child’s ability to plan or organise activities

40. Difficulty understanding consequences of own actions (e.g., climbs in dangerous

places, careless in traffic)   
41. Difficulty planning and preparing for tasks (e.g., collecting equipment needed for
an outing or for school)   
42. Difficulty completing sequential tasks (e.g., young children: getting dressed in the
morning without constant reminders; older children: completing home work
without constant reminders)   
Do problems with planning/organising interfere with your child’s daily function?
Not at all  A little  Pretty much  Very much 

3
 Does not Applies Applies
apply sometimes/
to some
extent

Perception of space and directions; the child’s perception of space and directions in the physical world:
43. Difficulty finding his/her way around (even in well known places)   
44. Seems disturbed by height differences (even slight) such as in connection with
climbing stairs etc.   
45. Difficulty judging distance or size   
46. Difficulty comprehending orientation and spatial directions (young children
turning clothes back to front, older children confusing letters such as b, p, d, or
digits such as 6, 9)   
47. Bumps into other people, especially in narrow places   

Concepts of time; the child´s ability to understand concepts of time:

48. Poor concepts of time, e.g., does not have an intuitive feeling for how long “five
minutes” or “one hour” take or is uncertain about how long ago something
happened   
49. Has only a vague idea about what time it is, whether it is morning or afternoon,
whether it is time or not to go to school   
50. Repeatedly asks about when something is going to happen, e.g., how much time
is left before an outing or before it is time to go to school   
51. Can read the clock mechanically but does not understand the actual time
concept   

Perception of own body; the child’s perception of his/her own body and sensory impressions:
52. Does not have a sense of how clothes fit, does not straighten socks or trousers
that have slid down   
53. Surprisingly poor perception of cold, pain etc   
54. Poor body awareness (uncertain of size of own body in relation to the
environment, e.g., bumps into or tumbles over things without intention to do
so)   
55. Oversensitive to touch (is irritated by tight clothing, perceives soft touch as
rough etc)   
56. Difficulty imitating other people’s movements   

Perception of visual forms and figures; the child’s ability to perceive forms and figures:
57. Tends to misinterpret pictures; e.g., may perceive a picture of a fried egg as that
of a flower   
58. Difficulty noticing small differences in shapes, figures, words and patterns that
look alike   
59. Difficulty drawing pictures such as that of a car, a house etc (compared with
children of similar age)   
60. Difficulty with jigsaw puzzles   
Do problems with perception of space and directions, time, own body, or forms and figures interfere with your child’s
daily function?
Not at all  A little  Pretty much  Very much 
4
 Does not Applies Applies
apply sometimes/
to some
extent

Memory; the child’s ability to remember facts or what he/she has experienced
61. Difficulty remembering information about personal data, such as date of birth,
home address etc   
62. Difficulty remembering the names of other people (e.g., name of teacher, school
peers)   
63. Difficulty remembering the names of weekdays, months and seasons   
64. Difficulty remembering non-personal facts learned at school (e.g., historic
events, chemical formulas etc)   
65. Difficulty remembering what has occurred recently, as who has phoned or, what
he/she ate a few hours ago etc   
66. Difficulty remembering events that occurred some time ago, such as what
happened on a trip, what Christmas presents he/she got etc   
67. Difficulty remembering where he/she put things   
68. Difficulty remembering appointments with peers or what home-work he/she has
got   
69. Difficulty learning rhymes, songs, multiplication tables etc by heart   
70. Difficulty remembering long or multiple-step instructions   
71. Difficulty acquiring new skills, such as rules of new play or games   
Do problems with memory interfere with your child’s daily function?
Not at all  A little  Pretty much  Very much 

Comprehension of spoken language; the child’s ability to

understand language and speech:

72. Difficulty understanding explanations and instructions   

73. Difficulty following stories read aloud   
74. Difficulty perceiving what other people say (often says “what?”, ”what do you
mean?”)   
75. Difficulty with abstract concepts such as “the day after tomorrow”, ”in the right
order”   
76. Tends to misinterpret what is said   

Expressive language; the child’s ability of language expression and to pronounce words:
77. Uncertain of speech sounds and tends to misarticulate words   
78. Difficulty learning the names of colours, people, letters etc   
79. Difficulty finding words or explaining to other people, says: “the, the, the ...”   
80. Tends to remember words incorrectly, says ”armbow” instead of ”elbow”,
refers to ”pointer” instead of ”index” etc   
81. Difficulty explaining what he/she wants   
82. Difficulty speaking fluently without any breaks   
83. Difficulty expressing him/herself in whole sentences, in grammatically correct
sentences, or inflecting words   
5
 Does not Applies Applies
apply sometimes/
to some
extent

84. Pronounces specific sounds incorrectly (has a lisp, difficulty pronouncing the
sound of ”r”, nasal voice etc)   
85. Difficulty pronouncing complex words such as ”electric”, ”screwdriver” etc   
86. Has a hoarse voice   
87. Stutters   
88. Speaks so rapidly that it is difficult to comprehend what he/she is saying   
89. Has a muddled speech   

Verbal communication; the child’s ability to use language and ability to communicate with others:
90. Difficulty telling about experiences or situations so that the listener understands
(e.g., what happened during the day or during the summer vacation)   
91. Difficulty keeping ”on track” when telling other people something   
92. Difficulty taking part in a conversation, e.g., problems shifting from listening to
talking   
Do problems with understanding of language, use of language, or verbal communication interfere with your child’s daily
function?
Not at all  A little  Pretty much  Very much 

Acquisition of academic skills; if the child is under 8 years of age, move to item 122
Questions relating to children’s learning can be difficult for parents without information from the child’s teacher.
Nevertheless, please try to respond to the following questions based on what you know or what you have heard from the
child’s teacher.

Reading, writing, arithmetic (only children 8 years or above):

93. Acquiring reading skills is more difficult than expected considering his/her
ability to learn other things   
94. Has difficulties to understand what he/she is reading   
95. Difficulty reading aloud at normal speed (reads too slowly, too quickly, or fails
to read fluently)   
96. Does not like reading (e.g., avoids reading books)   
97. Makes guesses while reading   
98. Difficulty spelling   
99. Has difficulties shaping letters and to write neatly   
100. Difficulty formulating him/herself in writing   
101. Difficulty acquiring basic math skills (addition, subtraction; i.e., plus, minus)   
102. Difficulty with math problems given in written form   
103. Difficulty learning and applying various mathematical rules   
104. Difficulty learning and use multiplication tables   
105. Difficulty with mental arithmetic   
6
 Does not Applies Applies
apply sometimes/
to some
extent

Learning new things and applying knowledge in school (only children 8 years or above):
106. Difficulty understanding verbal instructions   
107. Difficulty understanding or using abstract terms, e.g., terms relating to size,
volume, spatial directions   
108. Difficulty participating in discussions with other children   
109. Difficulty learning facts or acquiring knowledge about the surrounding world.   
110. Exceptional knowledge or skills in some area   
111. Is good at artistic or practical things (playing an instrument, drawing, painting,
construction work)   

Problem solving in school and approach to new learning situations (only children 8 years
or above):

112. Difficulty planning and organising activities, (e.g., the order in which things
should be done, how much time is needed to manage a specific task)   
113. Difficulty shifting plan or strategy when this is required (e.g., when the initial
approach failed)   
114. Difficulty comprehending explanations and following instructions given by
adults   
115. Difficulty solving abstract tasks (i.e., is dependent on learning material that can
be seen or touched)   
116. Difficulty keeping on trying and completing tasks, often leaves them half
finished   
117. Unmotivated for school work or comparable learning situations   
118. Learning is slow and laborious   
119. Does things too quickly, hastily, or in a hurry   
120. Can/will not take responsibility for own actions, needs a lot of supervision   
121. Very much in need of support, wants to know whether he/she is performing
well   
Do academic problems or learning difficulties interfere with your child’s daily function?
Not at all  A little  Pretty much  Very much 

Social skills; the child’s capacity to participate in social settings and interact with others
122. Does not understand other people’s social cues, e.g., facial expressions,
gestures, tone of voice, or body language   
123. Difficulty understanding the feelings of other people   
124. Difficulty responding to the needs of other people   
125. Difficulty verbally explaining emotions when feeling lonely, being bored etc   
126. Speaks with a monotonous or strange voice   
127. Difficulty expressing emotions and reactions with facial gestures or body
language   
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 Does not Applies Applies
apply sometimes/
to some
extent

128. Markedly ”old fashioned” style?   

129. Difficulty behaving as expected by peers   
130. Difficulty realising how to behave in different social situations, such as when
visiting relatives together with parents, when visiting friends, seeing a doctor,
going to the cinema, etc.   
131. Is perceived by peers as different, odd, or eccentric   
132. Unintentionally makes a fool of himself so that parents feel embarrassed or
peers start laughing   
133. Often seems to lack common sense   
134. Has a weak sense of humour   
135. Blurts out socially inappropriate comments   
136. Difficulty comprehending rules or prohibitions   
137. Often quarrels with peers   
138. Difficulty understanding and respecting other people’s rights, for example, that
younger children need more help than older ones, and that parents should be
left alone when they demand it, etc.   
139. Difficulty in group or team activities or games, invents new rules for own
benefit   
140. Difficulty making friends   
141. Does not often interact with peers   
142. Difficulty to participate in group activities   
143. Not accepted by other children to participate in their games   
144. Does not care for physical contact such as hugs   
145. Has one or a few interests that take up considerable time and that impinge on
relations with family and friends   
146. Repeats or gets stuck in seemingly meaningless behaviours or activities   
147. Gets very upset by tiny changes in daily routines   
148. Eye contact in face to face situations is abnormal or missing   
Do problems with social skills interfere with your child’s daily function?
Not at all  A little  Pretty much  Very much 

Emotional problems:
149. Poor self-confidence   
150. Seems to be unhappy, sad, depressed   
151. Often complains about feelings of loneliness   
152. Has tried to inflict bodily damage to him-/herself or talks about that   
153. Has a poor appetite   
154. Often expresses a feeling of being worthless or inferior to other children   
155. Often complains about bellyaches, headaches, breathing difficulties or other
bodily symptoms   
8
 Does not Applies Applies
apply sometimes/
to some
extent

156. Appears tense and anxious or complains about being nervous   

157. Becomes very anxious or unhappy when leaving home e.g., when setting to
school   
158. More sleeping problems than most children of similar age   
159. Often has nightmares   
160. Walks in sleep or has nocturnal attacks when he/she cannot be ”reached” or
comforted   
161. Often loses temper   
162. Often argues with adults   
163. Often refuses to follow the instructions of adults   
164. Often teases others by deliberately doing things that are perceived as
provocative   
165. Often blames others for own mistakes or bad actions   
166. Is easily offended, or disturbed by others   
167. Often gets into fights   
168. Is cruel to animals   
169. Lies and cheats   
170. Steals things at home   
171. Often destroys the belongings of other family members or other children   
172. Has recurrent episodes of a few days with extremely high activity level and
flight of ideas   
173. Has recurrent periods of obvious irritability   

Obsessive actions or thoughts; Actions or thoughts that he/she appears unable to control
174. Compulsively repeats some activities or has habits that are very difficult to
change   
175. Has obsessive/fixed ideas   
176. Has involuntary movements, tics, twitches or facial grimaces   
177. Repeats meaningless movements, such as head shaking, body jerking and finger
drumming   
178. Emits unmotivated sounds such as throat clearing, sneezing, swallowing,
barking, shouting etc   
179. Difficulty keeping quiet, e.g., whistles, hums, mumbles   
180. Repeats words or parts of words in a meaningless way   
181. Uses dirty words or language in an exaggerated way   
Do emotional problems, obsessive actions or thoughts interfere with your child’s daily function?
Not at all  A little  Pretty much  Very much 

9
 Does not Applies Applies
apply sometimes/
to some
extent

Describe the problems of your child that you are most worried about:

Describe the strengths of your child:

10