Change

• in sleep patterns (insomnia or extreme sleepiness, nightmares)
• in appetite (overeating or loss of appetite)
• in weight (notable gain or loss)
• in energy level (hyperactivity or exhaustion)
• in mood (more irritable, more excitable, or more depressed)
• in performance or activity (compulsive, erratic, or diminished)
• in personal appearance (lapse in grooming or hygiene)

Physical Complaints of Unknown Origin

• headaches, skeletal pain, gastrointestinal disturbances, cardiovascular problems, frequent illness or accidental injury, dizziness, extreme weakness

Withdrawal

• from activities and social interaction
• from emotional involvement with others
• from academic work and classroom participation

Emotional Overreaction

• spells of crying
• hypersensitivity
• outbursts of anger inappropriate to the situation
• violent behavior

Carelessness

• reckless driving
• excessive risk-taking
• sexual acting-out
• general impulsivity

Substance Abuse

• overuse or regular use of illicit drugs, alcohol, and/or medication (without medical monitoring)

Distraction

• inability to concentrate or focus
• persistent memory lapses
• restlessness
• preoccupation

Depression

• sense of pessimism and helplessness
• feeling out of control
• anxiety
• self-preoccupation
• negative self-evaluation
• references to suicide

Poor Contact with Reality

• irrational conversation
• obsessional ruminations or worrying
• exaggerated suspiciousness or fear
• apparent distortions of reality (auditory or visual hallucinations, inability to distinguish fantasy from reality), disorientation

Inappropriate Behavior

• behavior inappropriate to the setting or situation
• dangerous or threatening (to self or others) behaviors
• bizarre or strange behaviors
• antisocial acts (stealing, forcible sex, illegal pursuits)

Anxiety

• panic feelings
• physical shakiness
• obsessive and ruminating thoughts
• rapid heart rate
• shortness of breath