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Read each question carefully and completely. Take as much time as you need to reflect on each question. This tool is of no help to you if you refuse to answer each question honestly. Answers are completely confidential. No personal information is requested and your answers are not saved. Remember, if you cheat, you're only cheating yourself.
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1. |
Does your child come home with torn, damaged, or missing pieces of clothing, books, or other belongings? |
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2. |
Does your child have unexplained bruises, cuts, or scratches? |
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3. |
Is your child sad, moody, teary, or depressed when he/she comes home? |
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4. |
Does your child seem afraid of going to school, walking to and from school, riding the school bus, joining clubs, or other peer activities? |
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5. |
Does your child take a longer or illogical route when walking to or from school? |
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6. |
Has your child lost interest in school work or suddenly begun to do poorly in school? |
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7. |
Does your child have few, if any, friends? |
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8. |
Does your child often appear anxious? Does he/she suffer from low self-esteem? |
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9. |
Has your child experienced a loss of appetite? |
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10. |
Does your child complain frequently of headaches, stomachaches, or other physical ailments? |
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11. |
Does your child have trouble sleeping or often have bad dreams? |
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| Total 'Yes' |
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(out of 11 possible) |
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| Interpretation |
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