WHO DAS 2 Children and Youth

36-Item Version
To Be Completed by Youth ages 11 and older
Parent\Guardian to complete for youth 10 and Under



Patient [identifier](*)
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Patient's DOB(*)
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Date of Assessment(*)
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Informant [identifier](*)
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This questionnaire asks about problems you may have due to health conditions. Health conditions include diseases, illnesses, or other health problems that may be short- or long-lasting injuries, mental or emotional problems, or problems with alcohol or drugs.

Think back over the last 30 days and answer these questions, thinking about how much difficulty you have had doing the following activities. For each question, please choose only one response.

(H1) How do you rate your health overall health in the past 30 days?(*)
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In the last 30 days, how much difficulty did you have in:

Understanding and Communicating


(D1.1) Concentrating for 10 minutes at a time or more while doing homework, playing a game, or doing something you were asked to do?(*)
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(D1.2) Remembering to do important things, such as crossing the street safely, taking the right books to school, and remembering to do homework assignments?(*)
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(D1.3) Finding a way to deal with common, everyday problems that other people your age can manage?
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(D1.4) Learning how to do something new, for example, how to play a new game, or learning something new at school?
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(D1.5) Generally understanding what people say?
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(D1.6) Telling your family or friends about things you have done, or people you have met, or places you have been?
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In the last 30 days, how much difficulty did you have in:

Getting Around


(D2.1) Standing for a reasonable period of time, for example, in PE or school assembly or church/temple?
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(D2.2) Getting up from a sitting position?
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(D2.3) Moving around inside your home?
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(D2.4) Getting around at school or at a friend’s?
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(D2.5) Walking for as long a distance as other people your age can?
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Self-care


(D3.1) Keeping yourself and your clothes clean, taking baths or showers, and brushing your teeth without being asked?
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(D3.2) Getting dressed on your own?
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(D3.3) Eating meals without help?
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(D3.4) Staying safe when you are alone or not putting him/herself in danger when there are no adults around?
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In the last 30 days, how much difficulty did you have in:

Getting Along with People


(D4.1) Getting along with people you do not know well?
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(D4.2) Keeping a friendship?
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(D4.3) Getting along with family members?
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(D4.4) Making new friends?
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(D4.5) Getting along with your teachers or adults who aren’t in your family?
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Life Activities


(D5.1) Doing chores or other things you are expected to do at home to help out?
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(D5.2) Finishing chores or home activities that you are supposed to do?
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(D5.3) Doing chores or other home activities well?
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(D5.4) Doing these home activities quickly when it is important?
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IF YOU GO TO SCHOOL, COMPLETE QUESTIONS D5.5–D5.9 BELOW. OTHERWISE, SKIP TO D6.1

(D5.5) Doing your regular school assignments?
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(D5.6) Studying for important school tests?
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(D5.7) Completing all of the school assignments and activities that you needed to do?
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(D5.8) Getting your school work done as quickly as needed?
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(D5.9) How much difficulty do you have in following rules or fitting in with others at school?
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Participation in Society


(D6.1) Do you have more of a problem joining in on community activities (for example, clubs, religious groups, or after-school activities) than you thought you should?
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(D6.2) How much do you feel that you are not getting invited to many as parties, play dates, or just hanging out, as you would like?
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(D6.3) How much time do your parents or other family member spend on your health condition problems you may have?
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(D6.4) How much have you been upset by his/her health condition?
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(D6.7) How much of a problem do you have in doing things by yourself for relaxation or pleasure (do you have any problems keeping yourself busy doing things that you like to do)?
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(H2) Overall, how much did these difficulties interfere with your life?
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(H3) Overall, in the past 30 days, how many days were these difficulties present?
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(H4) n the past 30 days, for how many days were you totally unable to carry out your usual activities or school/work because of any health condition?
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(H5) In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or school/work because of any health condition?
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(H6) In the past 30 days, how many days were you absent from school?
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(H7) In the past 30 days, how many days were you late for school?
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