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  • In the past 7 days I have been able to remember things as easily as usual without extra effort
  • In the past 7 days My child was so angry he/she felt like throwing something.
  • In the past 7 days My child could keep up when he/she played with other kids.
  • In the past 7 days I felt sad
  • In the past 7 days, My child had a headache.
  • Thinking about the past 4 weeks, I had what I wanted in life.
  • In the past 7 days My child's chest felt tight because of asthma.
  • In the past 7 days My child felt wheezy because of his/her asthma.
  • In the past 7 days I worried when I was at home
  • In the past 7 days Being tired made it hard for my child to play or go out with friends as much as he/she would like.
  • In the past 7 days My child could use a key to unlock a door.
  • In the past 7 days I felt fearful
  • In the past 7 days I felt uneasy
  • In the past 7 days My child was able to count on his/her friends.
  • In the past 7 days Other kids wanted to be with my child.
  • In the past 7 days My child felt mad.
  • In the past 7 days I had to force myself to get up in the morning
  • In the past 7 days, My child had trouble breathing, even when he/she was not exercising or playing hard.
  • Thinking about your child's life, My child is positive about his/her future.
  • In the past 7 days Being tired made it hard for me to play or go out with my friends as much as I'd like.
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