PSYCHOSIS
HALLUCINATIONS	P	C	S
	0	0	0	No information or N/A
Sometimes children, when they are alone, hear voices, see things, or smell things and they don't quite know where they come from.	1	1	1	Not at all - Absent
Has this happened to you?
Have you ever seen things that were not there?	2	2	2	Suspected / Possible
When did you?
What did you see?	3	3	3	Mild. Definitely present but subject is generally aware it is his imagination and usually able to ignore it. Occurs no more than once per week.
What did you hear?
Has there been anything unusual about the way things sounded?
How often have you heard these voices (noises)? (smell, feeling, visions) Is it some of the time, only now and then, most of the time, or all of the time?	4	4	4	Moderate. Generally believes in the reality of the hallucinations, but it has little influence on his behavior. (Or) Occurs at least once per week.
What do you think it is?
Do you think it is your imagination or real?	5	5	5	Severe. Convinced his hallucination is real and significantly effects his actions. i.e.; locks doors to keep pursuers away. (Or) Occurs frequently.
Did you think it was real when you (heard, saw. etc.) it?
What did you do when you (heard, saw, etc.) it?
	6	6	6	Extreme. Actions based on hallucinations have major impact on him or others: Unable to do school work because of constant "conversation." (Or) Occurs most of the time.
	PAST			__________	__________	__________
				P	C	S
DELUSIONS
	P	C	S
Do you know what imagination is? Tell me.
Sometimes does your imagination play tricks on you?	0	0	0	No information
What kind of tricks? Tell me more about them.
Do you have any ideas about things that you don't tell anyone because they might not understand?	1	1	1	Definitely not delusional
What are they?	2	2	2	Suspected.
Do you have any secret thoughts? Tell me about them.
Do you believe in other things that other people don't believe in? Like what?	3	3	3	Mild. Delusion definitely present but at times subject questions his false belief.
Is anybody out to hurt you ?
Does anybody control your mind or body (like a robot)?	4	4	4	Moderate. Generally has conviction in his false belief.
Is anything happening to your body?
Do you ever feel the world is coming to an end?
Do you ever think you are an important or great person? Who?	5	5	5	Severe. Delusion has a significant effect on his actions, e.g., often asks family to forgive his sins, preoccupied with belief that he is a new Messiah
Are you sure that this (... ?) is that way?
Could there be any other reason for it?
How do you know that it happens as you say?	6	6	6	Extreme. Actions based on delusions have major impact on him or others, e.g., stops eating because believes food is poisoned
Any other possible explanations?
Do you enjoy making up stories like this?
Or is it different from making up stories?
(you might suggest other possible explanations and see how the subject reacts to them)
	PAST:			_______	_______	_______
				P	C	S
Do you think it could be your imagination ?
What did you do about...?