TEMPRANA DE PROBLEMAS
EN NIOS Y ADOLESCENTES
POR NED OWENS Y BETTY WHITE OWENS
Nombre: ________________________________________
Fecha de Nacimiento: _____________________________
Edad: _____aos _____meses
Sexo:______________
Escuela: ________________________________________
Grado:__________________________________________
Nombre de la Madre: ______________________________
Nombre de Padre: ________________________________
Direccin: _______________________________________
Telfono:________________________________________
Fecha de aplicacin:_______________________________
Evaluador: __________________ Relacin: ____________
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4.
5.
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Observaciones:___________________________________________________________________
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10
Observaciones____________________________________________________________________
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PROTOCOLO DE CALIFICACION
PUNTAJE
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
1. INATENCIN
PROB.
ORGANICOS
2. IMPULSIVIDAD
3.HIPERACTIVIDAD
4.CONTROL DE IRA
5. ACADEMIC0
PROB.
EMOCIONALES
6. ANSIEDAD
7. CONFIANZA EN
SI MISMO
8. AGRESIVIDAD
9. OPOSICIN
10. SOCIAL
NORMAL
EN RIESGO
ALTO RIESGO