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  • In the past 7 days, when my child was in pain it showed on his/her face.
  • In the past 7 days I am disappointed in my ability to meet the needs of my friends
  • In the past 7 days, How many days was your child strong enough to pour a drink from a full pitcher or carton?
  • In the past 7 days My child could keep up when he/she played with other kids.
  • In the past 7 days My child felt like something awful might happen.
  • In the past 7 days My child got scared really easy.
  • In the past 7 days My child could walk up stairs without holding on to anything.
  • In the past 7 days I felt helpless
  • In the past 7 days I could pull a shirt on over my head by myself.
  • Thinking about the past 4 weeks, I was satisfied with my life.
  • Considering your shortness of breath <u>over the past 7 days</u>, rate the amount of difficulty you had when doing the following activities: Dressing yourself without help
  • Considering your shortness of breath <u>over the past 7 days</u>, rate the amount of difficulty you had when doing the following activities: Making a bed
  • In the past 7 days I worry about doing well in school
  • In the past 7 days Being tired made it hard for my child to keep up with schoolwork.
  • In the past 7 days I felt exhausted
  • In the past 7 days I felt that I had no energy
  • In the past 7 days My child could open the rings in school binders.
  • In the past 7 days I got tired easily.
  • In the past 7 days I have had to work really hard to pay attention or I would make a mistake
  • In the past 7 days I was able to talk about everything with my friends.
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