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SECOND EDITION
for children and adolescents

Combination Booklet

Please read instructions at the top of each inside page.

Background Information
28/10/2004
Name:---------------------------- Date of Birth: _ _ _ _ _ _ __

Today's Date:. _ _ _ _ _ _ __ Location:. _________________________

Sex: D Female D Male Grade:. ___________ ID:, _ _ _ _ _ _ _ _ __

Parent/Guardian Name:--------------------------------------

PsychCorp is an imprint of Pearson Clinical Assessment.

ePsychCorR
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Copyright© 2001 NCS Pearson, Inc. All rights reserved .
Warning: No part of this publication may be reproduced or transmitted in any form or by any means,
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other countries of Pearson Education, Inc., or its affiliate(s).
Printed in the United States of America.
 Here is a list of things that happen to people and that people think or feel. Read each sentence
carefully, and circle the .Q.Ile word (Never, Sometimes, often, or Always) that tells about you best.
THERE ARE NO RIGHT OR WRONG ANSWERS.
0 1 2

1. I work hard. [ Never ·~ [sorqEtimes] kJOrtent; I

2. I feel strong.
____! f SoJP,etim~ F Ofte
3. I like myself. [ Never I [Sometimes] _,----- --=
4. People want to be with me. Never I ! SonietimesJ _i_ __ _ , - -~

5. I am just as good as the other kids. C Never ] ISometimes l I•' Often

6. I feel normal. [ } lever J @ metinies 11 . Often

7. I am a good person. {t,,;Ne~~ ; ·1 (sonie~ es I _i_ __ _ . _ _ _....._.

8. I do things well. ffl$N?,,!?W § ometim~ I Qften :J CJ\lways :

9. I can do things without help. li$flir111 f:Mfile,ti!D~f t;;OJten 'a 11 Always 1

1o. I feel smart. I t" i\(ways j

[$,Qnf¢tiine"sj Ji: o) ten
11 . People think I'm good at things. ~ rll ~iim& J f Orien l [ Always j
12. I am kind to others. fli~e@d t~if!~jrtiies) f Often i I Always J
13. I feel like a nice person. w~~,rm tSometim,§sJ i- Often 7 I !H,w!J
14. I am good at telling jokes.

15. I am good at remembering things. a Ne~er a fsorii:~times] (;;ortin'\;) h Always]

16. I tell the truth. Never :11 Sometim~l K;* Otte.£ ,;J Always J
17. I feel proud of the things I do. Nel'er !) ISornetu~'ii~ IRPJ'ten e ·'] [ fl' Alwayi]
18. I am a good thinker. L J kSomejinfis1 i;;: Often I AiwayU

19. I like my body.

20. I am happy to be me. lJ Never ]J rS6irietime]1 f 1 ffi&n , GAiwayi::

BSCI-Y
Total RS

2
 •

Here is a liSt of .th ings that happen to people and that people think or feel. Read each sentence
caref~lly, ~nd circle the one word (Never, Sometimes, Often, or Always) that tells about you best,
especially m the last two weeks. THERE ARE NO RIGHT OR WRONG ANSWERS.
0 1 2 3
] 21 . I worry someone might hurt me at school. L;Never ' 11 Some~ es] [ Of!en ,. I C Always

J 22. My dreams scare me. l Never J fSo~ etimes] r o gen ·, I iJ

t 23. I worry when I am at school. Neyer I [ S(!Rlefl~~ tt ·orten ' ]

I 24. I think about scary things. r Never I f Sometime'ij r,.o!t;i f I

J 2s. I worry people might tease me. Never ) [ sometimes I (; Of!en
51 e
J !,,Ywayi ]

I 26. I am afraid that I will make mistakes. [ Never 11 Sometimi?) L Ofti n !:I g~l)fays: )
I 21. I get nervous. C Never I rSoml timesJ C Often I CAi\\'ays··9
II

J 28. I am afraid I might get hurt. C Never J [ S,ometimes 11 Often I t .) \ 1ways·3

j

I 29. I worry I might get bad grades. I N,.~ r I [ Sometimes] F Often J CAlajs m
I 3o. I worry about the future.
t Ney~( ] l:$ometim~ I Often ) CAlways j
i;f4(~~1v~r ,!i I (Sometimes] LJ Ofte!l· ] [ Always , I
I 31 . My hands shake.

I 32. I worry I might go crazy.

I .!;'lever :J [Sortjetiijtes I f Often I L 'Always fl]
1

E N~~~r* af Sofuetimeil C O(ten 1CAlf BY,S ,

1 33. I worry people might get mad at me.

I 34. I worry I might lose control.

L NeVer1' I rs ~inetimes 11 Often ) r:· Al;;.ays
I 3s. I worry.
C Never ] [ sometimes 11 ' Often J r Alway£ ]
I 36. I have problems sleeping.
I Never ) ( ~ofuetimesJ I ·Often J I Always J
[?Neyer I [Sometimes I c: Often , ' [ Always . I
I 37. My heart pounds.
I 38. I get shaky.
I 39. I am afraid that something bad might happen to me.
[ t'lever !) [SomeJimes I ( Often
Nevel'
Always i I

ISometimes] r Often I I Always. I

i"
Never ) [ Sometimes I F Often
I 40. I am afraid that I might get sick.
BAI-Y
Total RS

3
 Here·1
s a list of th'
carefully and . ings that happen to people and that people think or feel. Read each sentence
. ' in the circle
la the one word (Never, Sometimes, Often, or Always) that te 11 s ab ou t you best ,
l especially
st two weeks. THERE ARE NO RIGHT OR WRONG ANSWERS.
0 1 2 3
41. I think that my hfe
.
is bad. L Neve~;] [ s~fuetimii] [ Often ! LAlway[]
42. E:Never ] @opietlll\e~ t,i\.Qften ] f Alwayfj
I have trouble doing things.
43.
I feel that I am a bad person. r Never :J (So,metiin~ ['.:: Ofteijt11 :· t L Alwai5
44. I wish I were dead. L Neve~; .:J fS9metimesi f::O!'tili J(' Always]
45. I have trouble sleeping. E1, N€v(;r ] [ Sometµnes] (. ':orti n · ·l ! l. Alway!]
1

46. I feel no one loves me. E;i~ev~~-j fspn;tim~] i4fOften d f" Always]
47. I think bad thmgs
· happen because of me.
48. I feel lonely. E l]@i.~gniJs) r:){Often ! , I Always]
49. My stomach hurts. /J e . (~gffi~t~i) ;,g '1£A1ways ]

50. I feel like bad things happen to me.

51 . I feel like I am stupid.

[s~µ;fiiE W• Qft~ :f , LAlways I

52. I feel sorry for myself.

53. I think I do things badly.

54. I feel bad about what I do.

55. I hate myself.

56. I want to be alone.

57. I feel like crying.

58. I feel sad.

I feel empty inside. f:ji\»1'J.t@~JC:::,o:@il;J [
["'Ne,/e/iii!9 AJwai]
59.
[· ,i:@•~ l&oni~liin~ lt'brtin I [
~G~O-~~~:_.:~_::_-------------=====~~~B
=D
I think my life will be bad.
~I-Y~c-:-;:-·::-j Total RS .
AJwai]

4
 Here is a list of .things th ath appen to people and that people think or feel. Read each sentence
ca refull y, an d circ 1e the one d (N .
THERE ARE NO RIGH - wor ever, Sometimes, Often, or Always) that tells about you best.
T OR WRONG ANSWERS.
0 1 2 3
61 . I think people try to cheat me. t ',l~Je~ !;] [~o'meti.nifS] f ,Qften I ' Always J
62. I feel like screaming. r Never' i 1·soiJ!et§ iJ i r :, Always I

63. I think people are unfair to me.

64. I think people try to hurt me. Never 1("soiiu~time~] c'. ·ot!iEll t;;1.1~ays 1
65. I think my life is unfair. L Never i (Wm1tip~~, L Of~~n ·, a s.: I

66. People bully me. I Never I [ sometimes) L Often '

67. People make me mad. I Ne~ r I [sometimes 11 Oft~n ]

68. I think people bother me. , Never I [ sometimes l [ · Qften 1E;\lwa~S 1

69. I get mad at other people. [ . Nevef ,:] [ [ o~ et!!!!@J F Often 11 4l'!!'YS l

70. When I get mad, I stay mad. tiN~r~r ·:; [ sometimes] I Often " I L ~lwayi ;.1

71. When I get mad, I have trouble getting over it. E'.::N~ v,?,t:; J ' Sometimes I r;- Often I L A,lways ·i
72. I think people try to control me. "Neveu ' So~etimesJ I Often l [; Ah\.~is )
73. I feel people try to put me down. i· · J~ever ·, J [ Sometimes I Often L Always i
74. I feel mean.
. Never ISometimes I t; Often ;,J I dAi;v:ays J
75. I feel like exploding.
Never j J[ Sometim'esl r::;often illl I Ajways

76. I think people are against me.

r Never~ I (fu)inetimes} t Often: J r Always J
77. I get angry.
[: ~ ver :J [,Sqm;tiiiie~I ~; Often° ¾] L Always
78. When I get mad, I feel mad inside my body.
t~:' Never :. ] & ~~t'fin}s] &;··J )ften ] I Always

79. I hate people.

[:Ne~er"~ J f) ,g ~tjm.;J t . qJten J 1. Always

CF Never ;! (s'.om,;e~i,nt} s] I Often ,] I Alw~ s

so. I get mad.
BANI-Y
Total RS

5
 Here is a list of things that happen to people and that people think or feel. Read each sentence
carefully, and circle the one word (Never, Sometimes, often, or Always) that tells about you best.
THERE ARE NO RIGHT OR WRONG ANSWERS.
0 1 2 3

81 . I steal. I m,N~~r, J [§?~ ettme§] I Often I[ A1w2L]

82. Other people get me into trouble.

83. I think about running away from home.

84. I do mean things._

85. I break into cars, houses, or other places.

86. I fight with others.

87. I like getting people mad.

88. I skip school. f Never J fsometinies I I Often "~ ~#i~~-

89. I hate listening to other people. [;.,Never ] [ Sometimes I [ Ofte ~~iy~J
90. I argue with adults. r: Never" J [Sqm.~«mes) I Orte ;' aft
91 . I hurt people.

92. I like being mean to others.

93. I break the rules.

94. I like it when people are scared of me. .......,........,_ [S6fue~ lsl c; orte,ti) f AlwiysjJ

95. I like to hurt animals.

96. I like to bully others. L arSj,fuetimesJ [-,, Ofte CAlwaxi]

97. I tell lies.

98. I like to trick people. DNev' 1~§9me#mes] :::::: R;AJw~ysJ

99. I break things when I am mad.

100. I swear at adults.

BDBI-Y
Total RS

6
 For Office Use Only After All Testing Is Complete
Wh~n the b~oklet is returned, ensure that all items are completed. Follow the instructions below to score
the inventories.

Sif on page 2, total the value of the responses for Use Tables A.1-A.3 to convert the raw scores to
th ibems of the inventory. Record the total raw score T scores. The tables are presented age-by-sex across
in e ox at the bottom of the page. Repeat this for the five inventories.
pages 3-6.
Enter the T score for each inventory in the corresponding
~ransfer each total raw score to the total raw score box T score box (in the row labeled TS). The profile can be
(in the row labeled Total RS) for the inventory. plotted after the T scores are obtained.

T Score Profile

T Score

100+
To~~

rs
BSCI-Y
NfoU:U
~13 - BAI-Y

ffi-&HWi
.........
w TScore

100+

95 95

90 90

85 85

80 80

75 75

70 70

65 65

60 60

55 55

50 50

45 45

40
40

35
35

L--------------------------_,J
S30 S30

7
 For Office Use Only (Complete after testing and detach)

Name: Date:. _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
·------------- Grade: _ _ _ _ _ _ __
Sex: Female Male Age: _ _ _ _ __

Referral Information
Referred by:. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Reason for Referral: ------------------------------

Clinical Information Educational Information

Treatment Status Education Status
Intake: School:. _ _ _ _ _ _ _ _ _ _ _ _ _ __

Review: Teacher: _ _ _ _ _ _ _ _ _ Grade: _ __

Other:
Comments:. _ _ _ _ _ _ _ _ _ _ _ _ __
Comments:· - - - - - - - - - - - - - -

Assessment fnformation · ·
Testing Observation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Testing Results
Elevated Scores:. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Critical Items:. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Recommended Action:. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

OPsychCorP.
PEARSON Copyright © 2001 NCS Pearson, Inc. All rights reserved.

25 26 27 28 A B C D E 281118·3 65432
Product Number 01586035
83
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