Child Questionnaire

Please read each statement on the following pages and select the answer that most closely describes the way each of your parents act toward you.

Select: Not Like if you think the statement describes a person who is not like your parent.

Select: Somewhat Like if you think the statement describes a person who is somewhat like your parent.

Select: A Lot Like if you think the statement describes a person who is a lot like your parent.

Your Information
Parent Information
Clinician
1a. My mother makes me feel better after talking over my worries with her.
2a. My mother tells me of all the things she has done for me.
3a. My mother believes in having a lot of rules and sticking with them.
4a. My mother smiles at me often.
5a. My mother says, if I really cared for her, I would not do things that cause her to worry.
6a. My mother insists that I must do exactly as I am told.
7a. My mother is able to make me feel better when I am upset.
8a. My mother is always telling me how I should behave.
9a. My mother is very strict with me.
10a. My mother enjoys doing things with me.
11a. My mother would like to be able to tell me what to do all the time.
12a. My mother gives hard punishment.
13a. My mother cheers me up when I am sad.
14a. My mother wants to control whatever I do.
15a. My mother is easy with me.
16a. My mother gives me a lot of care and attention.
17a. My mother is always trying to change me.
18a. My mother lets me off easy when I do something wrong.
19a. My mother makes me feel like the most important person in her life.
20a. My mother only keeps rules when it suits her.
21a. My mother gives me as much freedom as I want.
22a. My mother believes in showing her love for me.
23a. My mother is less friendly with me, if I do not see things her way.
24a. My mother lets me go anyplace I please without asking.
25a. My mother often praises me.
26a. My mother will avoid looking at me when I have disappointed her.
27a. My mother lets me go out any evening I want.
28a. My mother is easy to talk to.
29a. My mother if I have hurt her feelings, stops talking to me until I please her again.
30a. My mother lets me do anything I like to do.
1b. My father makes me feel better after talking over my worries with him.
2b. My father tells me of all the things he has done for me.
3b. My father believes in having a lot of rules and sticking with them.
4b. My father smiles at me often.
5b. My father says, if I really cared for him, I would not do things that cause him to worry.
6b. My father insists that I must do exactly as I am told.
7b. My father is able to make me feel better when I am upset.
8b. My father is always telling me how I should behave.
9b. My father is very strict with me.
10b. My father enjoys doing things with me.
11b. My father would like to be able to tell me what to do all the time.
12b. My father gives hard punishment.
13b. My father cheers me up when I am sad.
14b. My father wants to control whatever I do.
15b. My father is easy with me.
16b. My father gives me a lot of care and attention.
17b. My father is always trying to change me.
18b. My father lets me off easy when I do something wrong.
19b. My father makes me feel like the most important person in his life.
20b. My father only keeps rules when it suits him.
21b. My father gives me as much freedom as I want.
22b. My father believes in showing his love for me.
23b. My father is less friendly with me, if I do not see things his way.
24b. My father lets me go anyplace I please without asking.
25b. My father often praises me.
26b. My father will avoid looking at me when I have disappointed him.
27b. My father lets me go out any evening I want.
28b. My father is easy to talk to.
29b. My father if I have hurt his feelings, stops talking to me until I please him again.
30b. My father lets me do anything I like to do.