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  • In the past 7 days, My child felt peaceful.
  • In the past 7 days I felt mad.
  • In the past 7 days I was so angry I felt like throwing something.
  • In the past 7 days, My child had trouble concentrating.
  • In the past 7 days, My child felt stressed.
  • In the past 7 days, How many days were you strong enough to carry heavy things with your hands?
  • Thinking about your child's life, My child is hopeful about his/her future.
  • In the past 7 days My child had trouble doing schoolwork when he/she had pain.
  • <u>Over the past 7 days</u>, how short of breath did you get with each of these activities? Preparing meals
  • In the past 7 days I felt comfortable talking with my friends
  • In the past 7 days I felt I had no reason for living
  • In the past 7 days My child could not stop feeling sad.
  • In the past 7 days, How many days did your child exercise so much that he/she breathed hard?
  • In general, would you say your child's quality of life is:
  • In the past 7 days I felt lonely.
  • Smoking is relaxing.
  • In the past 7 days, when I was in pain I had to stop what I was doing.
  • In the past 7 days I am satisfied with how much work I can do (include work at home)
  • Are you able to pick up coins from a table top?
  • In the past 7 days I had trouble sleeping when I had pain.
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