Attachment 31 | |||||||
Emotional Health Questionnaires for Toolbox |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, OVERVIEW | |||||||||||
Subdomain | Concept | Measure | Item Count | Measure | Item Count | Measure | Item Count | Measure | Item Count | Measure | Item Count |
ADULT SELF-REPORT (18+) | PEDS SELF-REPORT (13-17) | PEDS SELF-REPORT (8-12) | PEDS PROXY REPORT (8-12) | PEDS PROXY-REPORT (3-7) | |||||||
Negative Affect | Anger | PROMIS - Anger Item Bank | 29 | ||||||||
PROMIS - Anger SF (8 items) | PedsPROMIS - Anger SF | 6 | PedsPROMIS - Anger SF | 6 | |||||||
AESC-10 | 10 | ||||||||||
BPAQ - Hostility | 6 | ||||||||||
BPAQ - Physical Aggression | 5 | ||||||||||
HBQ - Overt Agression | 9 | ||||||||||
Fear | PROMIS - Anxiety Item Bank | 28 | |||||||||
PROMIS - Anxiety SF (7 items) | PedsPROMIS - Anxiety SF | 8 | PedsPROMIS - Anxiety SF | 8 | |||||||
SCARED-10 | 10 | ||||||||||
HBQ - Over Anxious | 6 | ||||||||||
HBQ - Separation | 7 | ||||||||||
MASQ - Somatic Anxiety | 6 | ||||||||||
Sadness | PROMIS - Depression Item Bank | 28 | |||||||||
PROMIS - Depression SF (8 items) | PedsPROMIS - Depression SF | 8 | PedsPROMIS - Depression SF | 8 | |||||||
SMFQ-11 | 11 | ||||||||||
HBQ - Depression | 7 | ||||||||||
Subdomain Total | 102 | Subdomain Total | 22 | Subdomain Total | 22 | Subdomain Total | 31 | Subdomain Total | 29 | ||
Positive Affect | Positive Feeling States | Toolbox - Happiness | 8 | PedsToolbox - Positive Affect (PA) | 16 | PedsToolbox PA (Happiness) | 10 | Peds Toolbox Proxy PA (Happiness) | 3 | PedsToolbox Proxy PA (Happiness) | 9 |
Toolbox - Serenity | 8 | PedsToolbox PA (Serenity/Cognitive Engagement) | 5 | Peds Toolbox Proxy PA (Cognitive Engagement) | 6 | ||||||
Toolbox - Cognitive Engagement | 5 | ||||||||||
(additional PFS Bank Items) | 13 | PedsToolbox Proxy PA (Elation) | 3 | ||||||||
High Intensity Pleasure | 5 | High Intensity Pleasure | 14 | Smiling & Laughter | 5 | ||||||
Life Satisfaction | Satisfaction with Life Scale (+2 items modified for readability) | 7 | Satisfaction with Life Scale (+2 items modified for readibility) | 7 | |||||||
Students' Life Satisfaction Scale (modified) | 7 | Students' Life Satisfaction Scale | 7 | Students' Life Satisfaction Scale | 7 | Students' Life Satisfaction Scale (modified) | 7 | Students' Life Satisfaction Scale (modified) | 7 | ||
Domain-Specific Life Satisfaction | 10 | Domain-Specific Life Satisfaction | 9 | Domain-Specific Life Satisfaction | 10 | Domain-Specific Life Satisfaction | 8 | ||||
Meaning | Toolbox - Meaning | 8 | |||||||||
Subdomain Total | 56 | 40 | Subdomain Total | 36 | Subdomain Total | 43 | Subdomain Total | 29 | |||
Stress & Self-Efficacy | Perceived Stress | Perceived Stress Scale (+1 item modified for readability) | 15 | Perceived Stress Scale (modified) | 14 | Perceived Stress Scale (modified) | 14 | Perceived Stress Scale (modified) | 14 | ||
Coping Strategies | |||||||||||
Self-Efficacy | GSES | 10 | GSES | 10 | GSES | 10 | GSES | 10 | |||
GSES (modified response options) | 10 | GSES (modified response options) | 10 | GSES (modified response options) | 10 | GSES (modified response options) | 10 | ||||
How I Feel | 10 | How I Feel | 10 | How I Feel | 10 | ||||||
Subdomain Total | 35 | Subdomain Total | 44 | Subdomain Total | 44 | Subdomain Total | 44 | Subdomain Total | 0 | ||
Social Relationships | Social Support | Toolbox - Emotional/Informational Support | 8 | PedsToolbox - Emotional Support | 7 | PedsToolbox - Emotional Support | 7 | ||||
Toolbox - Instrumental Support | 8 | ||||||||||
PedsToolbox - Maternal Relationship | 3 | PedsToolbox - Maternal Relationship | 3 | ||||||||
PedsToolbox - Paternal Relationship | 3 | PedsToolbox - Paternal Relationship | 3 | ||||||||
PedsToolbox - Positive Parental Relationships | 5 | PedsToolbox - Positive Parental Relationships | 5 | ||||||||
PedsToolbox - Negative Parental Relationships | 4 | PedsToolbox - Negative Parental Relationships | 4 | ||||||||
Companionship | Toolbox - Friendship | 8 | PedsToolbox - Friendship | 5 | PedsToolbox - Friendship | 5 | |||||
PedsToolbox - Positive Peer Interactions | 4 | PedsToolbox - Positive Peer Interactions | 4 | ||||||||
Toolbox - Loneliness | 5 | PedsToolbox - Loneliness | 7 | PedsToolbox - Loneliness | 7 | ||||||
PedsToolbox - Social Withdrawal | 4 | PedsToolbox - Social Withdrawal | 4 | ||||||||
Social Distress | Toolbox - Perceived Insensitivity | 8 | PedsToolbox - Perceived Insensitivity | 7 | PedsToolbox - Perceived Insensitivity | 7 | |||||
Toolbox - Perceived Hostility | 8 | PedsToolbox - Perceived Hostility | 5 | PedsToolbox - Perceived Hostility | 5 | ||||||
PedsToolbox - Rejection by Peers | 9 | PedsToolbox - Rejection by Peers | 9 | ||||||||
PedsToolbox - Rejection by Sibs | 9 | PedsToolbox - Rejection by Sibs | 9 | ||||||||
Positive Social Development | PedsToolbox - Empathic Behaviors | 10 | PedsToolbox - Empathic Behaviors | 10 | |||||||
Subdomain Total | 45 | Subdomain Total | 37 | Subdomain Total | 37 | Subdomain Total | 45 | Subdomain Total | 45 | ||
OVERALL TOTAL | 238 | OVERALL TOTAL | 143 | OVERALL TOTAL | 139 | OVERALL TOTAL | 163 | OVERALL TOTAL | 103 | ||
Estimated Total Time | 28 min. | Estimated Total Time | 29 min. | Estimated Total Time | 28 min. | Estimated Total Time | 28 min. | Estimated Total Time | 19 min. | ||
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 18+ NA (SELF) | |||||
Item Count | Toolbox ID | Item Context | Item Stem | Response | Scale |
Anger - Affect | |||||
For the next set of questions, please tell us how true each statement was of you in the past 7 days. | |||||
1 | Anger30 | In the past 7 days: | When I was frustrated, I let it show. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
2 | Anger31 | In the past 7 days: | I was irritated more than people knew. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
3 | Anger32 | In the past 7 days: | I felt envious of others. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
4 | Anger33 | In the past 7 days: | I disagreed with people. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
5 | Anger34 | In the past 7 days: | I made myself angry about something just by thinking about it. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
6 | Anger35 | In the past 7 days: | I tried to get even when I was angry with someone. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
7 | Anger36 | In the past 7 days: | I felt angry. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
8 | Anger37 | In the past 7 days: | When I was mad at someone, I gave them the silent treatment. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
9 | Anger38 | In the past 7 days: | I felt like breaking things. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
10 | Anger39 | In the past 7 days: | I felt like I was ready to explode. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
11 | Anger40 | In the past 7 days: | When I was angry, I sulked. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
12 | Anger41 | In the past 7 days: | I felt resentful when I didn't get my way. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
13 | Anger42 | In the past 7 days: | I felt guilty about my anger. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
14 | Anger43 | In the past 7 days: | I felt bitter about things. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
15 | Anger44 | In the past 7 days: | I felt that people were trying to anger me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
16 | Anger45 | In the past 7 days: | I stayed angry for hours. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
17 | Anger46 | In the past 7 days: | I held grudges towards others. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
18 | Anger47 | In the past 7 days: | I felt angrier than I thought I should. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
19 | Anger48 | In the past 7 days: | I was grouchy. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
20 | Anger49 | In the past 7 days: | I was stubborn with others. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
21 | Anger50 | In the past 7 days: | I felt annoyed. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
22 | Anger51 | In the past 7 days: | I had a bad temper. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
23 | Anger52 | In the past 7 days: | I had trouble controlling my temper. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
24 | Anger53 | In the past 7 days: | I was angry when I was delayed. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
25 | Anger54 | In the past 7 days: | Even after I expressed my anger, I had trouble forgetting about it. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
26 | Anger55 | In the past 7 days: | I felt like I needed help for my anger. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
27 | Anger56 | In the past 7 days: | I was angry when something blocked my plans. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
28 | Anger57 | In the past 7 days: | I felt like yelling at someone. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anger |
29 | Anger58 | In the past 7 days: | Just being around people irritated me. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PROMIS: Anger |
Anger - Hostility | |||||
For the next set of questions, please tell us how true each statement is of you. | |||||
30 | Anger22 | How true of you is this statement? | I am sometimes eaten up with jealousy. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
31 | Anger23 | How true of you is this statement? | At times I feel I have gotten a raw deal out of life. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
32 | Anger24 | How true of you is this statement? | Other people always seem to get the breaks. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
33 | Anger25 | How true of you is this statement? | I wonder why sometimes I feel so bitter about things. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
34 | Anger28 | How true of you is this statement? | I sometimes feel that people are laughing at me behind my back. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
35 | Anger29 | How true of you is this statement? | When people are especially nice, I wonder what they want. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
Anger - Physical Aggression | |||||
36 | Anger02m | How true of you is this statement? | If I am provoked enough, I may hit another person. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
37 | Anger04 | How true of you is this statement? | I get into fights a little more than the average person. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
38 | Anger06 | How true of you is this statement? | There are people who pushed me so far that we came to blows. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
39 | Anger08 | How true of you is this statement? | I have threatened people I know. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
40 | Anger09 | How true of you is this statement? | I have become so mad that I have broken things. | 1-extremely untrue of me 2- 3- 4- 5- 6- 7-extremely true of me |
BPAQ: Buss-Perry Aggression Questionnaire |
Fear - Psychological | |||||
For the next set of questions, please tell us how true each statement was of you in the past 7 days. | |||||
41 | Anxiety36 | In the past 7 days: | I felt fearful. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
42 | Anxiety37 | In the past 7 days: | I felt frightened. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
43 | Anxiety38 | In the past 7 days: | It scared me when I felt nervous. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
44 | Anxiety39 | In the past 7 days: | I felt anxious. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
45 | Anxiety40 | In the past 7 days: | I felt like I needed help for my anxiety. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
46 | Anxiety41 | In the past 7 days: | I was concerned about my mental health. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
47 | Anxiety42 | In the past 7 days: | I felt upset. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
48 | Anxiety43 | In the past 7 days: | I had a racing or pounding heart. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
49 | Anxiety44 | In the past 7 days: | I was anxious if my normal routine was disturbed. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
50 | Anxiety45 | In the past 7 days: | I had sudden feelings of panic. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
51 | Anxiety46 | In the past 7 days: | I was easily startled. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
52 | Anxiety47 | In the past 7 days: | I had trouble paying attention. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
53 | Anxiety48 | In the past 7 days: | I avoided public places or activities. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
54 | Anxiety49 | In the past 7 days: | I felt fidgety. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
55 | Anxiety50 | In the past 7 days: | I felt something awful would happen. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
56 | Anxiety51 | In the past 7 days: | I felt worried. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
57 | Anxiety52 | In the past 7 days: | I felt terrified. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
58 | Anxiety53 | In the past 7 days: | I worried about other people's reactions to me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
59 | Anxiety54 | In the past 7 days: | I found it hard to focus on anything other than my anxiety. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
60 | Anxiety55 | In the past 7 days: | My worries overwhelmed me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
61 | Anxiety56 | In the past 7 days: | I had twitching or trembling muscles. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
62 | Anxiety57 | In the past 7 days: | I felt nervous. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
63 | Anxiety58 | In the past 7 days: | I felt indecisive. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
64 | Anxiety59 | In the past 7 days: | Many situations made me worry. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
65 | Anxiety60 | In the past 7 days: | I had difficulty sleeping. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
66 | Anxiety61 | In the past 7 days: | I had trouble relaxing. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
67 | Anxiety62 | In the past 7 days: | I felt uneasy. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
68 | Anxiety63 | In the past 7 days: | I felt tense. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Anxiety |
68.5 | Anxiety64 | In the past 7 days: | I had difficulty calming down. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
|
Fear - Somatic | |||||
For the next set of questions, consider how much you have felt or experienced things during the past week, including today. | |||||
69 | Anxiety13 | In the past 7 days: | I was short of breath. | 1 = Not at all 2 = A little bit 3 = Moderately 4 = Quite a bit 5 = Extremely |
MASQ-SF: Mood and Anxiety Symptom Questionnaire-Short Form: Subscales for General Distress (Anxiety) and Anxious Arousal |
70 | Anxiety24 | In the past 7 days: | I felt nauseous. | 1 = Not at all 2 = A little bit 3 = Moderately 4 = Quite a bit 5 = Extremely |
MASQ-SF: Mood and Anxiety Symptom Questionnaire-Short Form: Subscales for General Distress (Anxiety) and Anxious Arousal |
71 | Anxiety25 | In the past 7 days: | I felt dizzy or lightheaded. | 1 = Not at all 2 = A little bit 3 = Moderately 4 = Quite a bit 5 = Extremely |
MASQ-SF: Mood and Anxiety Symptom Questionnaire-Short Form: Subscales for General Distress (Anxiety) and Anxious Arousal |
72 | Anxiety28 | In the past 7 days: | My muscles twitched or trembled. | 1 = Not at all 2 = A little bit 3 = Moderately 4 = Quite a bit 5 = Extremely |
MASQ-SF: Mood and Anxiety Symptom Questionnaire-Short Form: Subscales for General Distress (Anxiety) and Anxious Arousal |
73 | Anxiety31 | In the past 7 days: | My heart was racing or pounding. | 1 = Not at all 2 = A little bit 3 = Moderately 4 = Quite a bit 5 = Extremely |
MASQ-SF: Mood and Anxiety Symptom Questionnaire-Short Form: Subscales for General Distress (Anxiety) and Anxious Arousal |
74 | Anxiety34 | In the past 7 days: | My muscles were tense or sore. | 1 = Not at all 2 = A little bit 3 = Moderately 4 = Quite a bit 5 = Extremely |
MASQ-SF: Mood and Anxiety Symptom Questionnaire-Short Form: Subscales for General Distress (Anxiety) and Anxious Arousal |
Sadness | |||||
For the next set of questions, please tell us how true each statement was of you in the past 7 days. | |||||
75 | Depression30 | In the past 7 days: | I felt worthless. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
76 | Depression31 | In the past 7 days: | I felt that I had nothing to look forward to. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
77 | Depression32 | In the past 7 days: | I felt helpless. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
78 | Depression33 | In the past 7 days: | I withdrew from other people. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
79 | Depression34 | In the past 7 days: | I felt that nothing could cheer me up. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
80 | Depression35 | In the past 7 days: | I felt that I was not as good as other people. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
81 | Depression36 | In the past 7 days: | I felt sad. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
82 | Depression37 | In the past 7 days: | I felt that I wanted to give up on everything. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
83 | Depression38 | In the past 7 days: | I felt that I was to blame for things. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
84 | Depression39 | In the past 7 days: | I felt like a failure. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
85 | Depression40 | In the past 7 days: | I had trouble feeling close to people. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
86 | Depression41 | In the past 7 days: | I felt disappointed in myself. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
87 | Depression42 | In the past 7 days: | I felt that I was not needed. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
88 | Depression43 | In the past 7 days: | I felt lonely. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
89 | Depression44 | In the past 7 days: | I felt depressed. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
90 | Depression45 | In the past 7 days: | I had trouble making decisions. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
91 | Depression46 | In the past 7 days: | I felt discouraged about the future. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
92 | Depression47 | In the past 7 days: | I found that things in my life were overwhelming. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
93 | Depression48 | In the past 7 days: | I felt unhappy. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
94 | Depression49 | In the past 7 days: | I felt I had no reason for living. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
95 | Depression50 | In the past 7 days: | I felt hopeless. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
96 | Depression51 | In the past 7 days: | I felt ignored by people. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
97 | Depression52 | In the past 7 days: | I felt upset for no reason. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
98 | Depression53 | In the past 7 days: | I felt that nothing was interesting. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
99 | Depression54 | In the past 7 days: | I felt pessimistic. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
100 | Depression55 | In the past 7 days: | I felt that my life was empty. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
101 | Depression56 | In the past 7 days: | I felt guilty. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
102 | Depression57 | In the past 7 days: | I felt emotionally exhausted. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Often 5 = Always |
PROMIS: Depression |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 8-17 NA (SELF) | |||||
Item Count | Concept ID | Item Context | Item Stem | Response | Scale |
Anger | |||||
For the next set of questions, please tell us how true each statement was of you in the past 7 days. | |||||
1 | PedRepAng13 | In the past 7 days: | I felt mad. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anger Item Bank |
2 | PedRepAng14 | In the past 7 days: | I was so angry I felt like yelling at somebody. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anger Item Bank |
3 | PedRepAng15 | In the past 7 days: | When I got mad, I stayed mad. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anger Item Bank |
4 | PedRepAng16 | In the past 7 days: | I felt fed up. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anger Item Bank |
5 | PedRepAng17 | In the past 7 days: | I was so angry I felt like throwing something. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anger Item Bank |
6 | PedRepAng18 | In the past 7 days: | I felt upset. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anger Item Bank |
Fear | |||||
For the next set of questions, please tell us how true each statement was of you in the past 7 days. | |||||
7 | PedRepAnx42 | In the past 7 days: | I felt scared. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anxiety Bank |
8 | PedRepAnx43 | In the past 7 days: | I worried about what could happen to me. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anxiety Bank |
9 | PedRepAnx44 | In the past 7 days: | I felt worried. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anxiety Bank |
10 | PedRepAnx45 | In the past 7 days: | I felt like something awful might happen. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anxiety Bank |
11 | PedRepAnx46 | In the past 7 days: | I worried when I went to bed at night. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anxiety Bank |
12 | PedRepAnx47 | In the past 7 days: | I thought about scary things. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anxiety Bank |
13 | PedRepAnx48 | In the past 7 days: | I felt nervous. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anxiety Bank |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
14 | PedRepAnx49 | In the past 7 days: | I was afraid that I would make mistakes. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Anxiety Bank |
Sadness | |||||
For the next set of questions, please tell us how true each statement was of you in the past 7 days. | |||||
15 | PedRepDep34 | In the past 7 days: | I felt like I couldn't do anything right. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Depression Item Bank |
16 | PedRepDep35 | In the past 7 days: | I felt everything in my life went wrong. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Depression Item Bank |
17 | PedRepDep36 | In the past 7 days: | I felt unhappy. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Depression Item Bank |
18 | PedRepDep37 | In the past 7 days: | I felt lonely. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Depression Item Bank |
19 | PedRepDep38 | In the past 7 days: | I felt sad. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Depression Item Bank |
20 | PedRepDep39 | In the past 7 days: | I felt alone. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Depression Item Bank |
21 | PedRepDep40 | In the past 7 days: | I thought that my life was bad. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Depression Item Bank |
22 | PedRepDep41 | In the past 7 days: | I could not stop feeling sad. | 0 = Never 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always |
PROMIS Pediatric Depression Item Bank |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 8-12 NA (PROXY) | |||||
Item Count | Concept ID | Item Context | Item Stem | Response | Scale |
Anger | |||||
For the next set of questions, please read each statement and choose the answer that best describes your child, or shows how your child usually feels. | |||||
1 | PedProxAng20 | Choose the answer that best describes your child, or shows how your child usually feels. | My child feels angry. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
2 | PedProxAng21 | Choose the answer that best describes your child, or shows how your child usually feels. | My child feels like yelling at someone. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
3 | PedProxAng23 | Choose the answer that best describes your child, or shows how your child usually feels. | My child gets very impatient if he/she has to wait for something. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
4 | PedProxAng24 | Choose the answer that best describes your child, or shows how your child usually feels. | My child loses his/her temper easily. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
5 | PedProxAng25 | Choose the answer that best describes your child, or shows how your child usually feels. | My child feels like breaking things. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
6 | PedProxAng26 | Choose the answer that best describes your child, or shows how your child usually feels. | My child feels grouchy or irritable. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
7 | PedProxAng27 | Choose the answer that best describes your child, or shows how your child usually feels. | My child gets in a bad mood when things don't go his/her way. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
8 | PedProxAng29 | Choose the answer that best describes your child, or shows how your child usually feels. | My child has a bad temper. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
9 | PedProxAng30 | Choose the answer that best describes your child, or shows how your child usually feels. | My child gets very angry if his/her parent or teacher criticizes him/her. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
10 | PedProxAng31 | Choose the answer that best describes your child, or shows how your child usually feels. | My child gets in a bad mood easily. | 1 - Almost never 2 - Sometimes 3 - Often 4 - Almost always |
AESC: Anger Expression Scale for Children |
Fear | |||||
For the next set of questions, please read each statement and choose the answer that best describes your child, or shows how your child usually feels. | |||||
11 | PedProxAnx55 | Choose the answer that best describes your child, or shows how your child usually feels. | My child worries about other people liking him/her. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
12 | PedProxAnx57 | Choose the answer that best describes your child, or shows how your child usually feels. | My child is nervous. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
13 | PedProxAnx64 | Choose the answer that best describes your child, or shows how your child usually feels. | My child worries about being as good as other kids. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
14 | PedProxAnx67 | Choose the answer that best describes your child, or shows how your child usually feels. | My child worries about going to school. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
15 | PedProxAnx71 | Choose the answer that best describes your child, or shows how your child usually feels. | My child worries about things working out for him/her. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
16 | PedProxAnx73 | Choose the answer that best describes your child, or shows how your child usually feels. | My child is a worrier. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
17 | PedProxAnx78 | Choose the answer that best describes your child, or shows how your child usually feels. | People tell me that my child worries too much. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
18 | PedProxAnx83 | Choose the answer that best describes your child, or shows how your child usually feels. | My child worries about what is going to happen in the future. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
19 | PedProxAnx85 | Choose the answer that best describes your child, or shows how your child usually feels. | My child worries about how well he/she does things. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
20 | PedProxAnx87 | Choose the answer that best describes your child, or shows how your child usually feels. | My child worries about things that have already happened. | 1 = Not true or hardly ever true 2 = Sometimes true or somewhat true 3 = Very true or often true |
SCARED: Screen for Anxiety Related Disorders |
Sadness | |||||
For the next set of questions, please indicate how much your child felt or acted the way described in the past 2 weeks. In other words, how true is the statement for the past 2 weeks? | |||||
21 | PedProxDep14 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child felt miserable or unhappy. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
22 | PedProxDep15 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child didn't enjoy anything at all. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
23 | PedProxDep18 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child felt s/he was no good anymore. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
24 | PedProxDep19 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child cried a lot. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
25 | PedProxDep20 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child found it hard to think properly or concentrate. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
26 | PedProxDep21 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child hated him/herself. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
27 | PedProxDep22 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child felt s/he was a bad person. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
28 | PedProxDep23 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child felt lonely. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
29 | PedProxDep24 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child thought nobody really loved him/her. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
30 | PedProxDep25 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child thought s/he could never be as good as the other kids. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
31 | PedProxDep26 | Please indicate how much your child has felt or acted this way in the past 2 weeks. How true is this statement? | My child felt s/he did everything wrong. | 0 = Not true 1 = Sometimes true 2 = True |
SMFQ: Short Mood and Feelings Questionnaire |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 3-7 NA (PROXY) | |||||
Item Count | Concept ID | Item Context | Item Stem | Response | Scale |
Anger | |||||
For the next set of questions, please indicate how often or true the behavior is of your child. | |||||
1 | PedProxAng01 | Please indicate how often or true the behavior is of your child. | Has temper tantrums or hot temper. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: oppositional-defiant subscale |
2 | PedProxAng02 | Please indicate how often or true the behavior is of your child. | Argues a lot with adults. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: oppositional-defiant subscale |
3 | PedProxAng03 | Please indicate how often or true the behavior is of your child. | Argues a lot with peers. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: oppositional-defiant subscale |
4 | PedProxAng05 | Please indicate how often or true the behavior is of your child. | Blames others for his/her own mistakes. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: oppositional-defiant subscale |
5 | PedProxAng06 | Please indicate how often or true the behavior is of your child. | Is easily annoyed by others. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: oppositional-defiant subscale |
6 | PedProxAng07 | Please indicate how often or true the behavior is of your child. | Is angry and resentful. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: oppositional-defiant subscale |
7 | PedProxAng08 | Please indicate how often or true the behavior is of your child. | Gets back at people. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: oppositional-defiant subscale |
8 | PedProxAng09m | Please indicate how often or true the behavior is of your child. | Swears or uses curse words. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: oppositional-defiant subscale |
9 | PedProxAng11 | Please indicate how often or true the behavior is of your child. | Does things that annoy others. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: overt hostility subscale |
Fear | |||||
For the next set of questions, please indicate how often or true the behavior is of your child. | |||||
10 | PedProxAnx29 | Please indicate how often or true the behavior is of your child. | Worries about things in the future. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Overanxious subscale |
11 | PedProxAnx31 | Please indicate how often or true the behavior is of your child. | Worries about past behavior. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Overanxious subscale |
12 | PedProxAnx32 | Please indicate how often or true the behavior is of your child. | Worries about doing better at things. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Overanxious subscale |
13 | PedProxAnx35 | Please indicate how often or true the behavior is of your child. | Is self-conscious or easily embarrassed. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Overanxious subscale |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
14 | PedProxAnx36 | Please indicate how often or true the behavior is of your child. | Needs to be told over and over that things are okay. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Overanxious subscale |
15 | PedProxAnx37 | Please indicate how often or true the behavior is of your child. | Is nervous, high strung or tense. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Overanxious subscale |
16 | PedProxAnx38 | Please indicate how often or true the behavior is of your child. | Worries that something bad will happen to people he/she is close to. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Separation anxiety subscale |
17 | PedProxAnx39 | Please indicate how often or true the behavior is of your child. | Worries about being separated from loved ones. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Separation anxiety subscale |
18 | PedProxAnx40 | Please indicate how often or true the behavior is of your child. | Avoids school to stay home. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Separation anxiety subscale |
19 | PedProxAnx43 | Please indicate how often or true the behavior is of your child. | Has nightmares about being abandoned. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Separation anxiety subscale |
20 | PedProxAnx44 | Please indicate how often or true the behavior is of your child. | Complains of feeling sick before separating from those he/she is close to. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Separation anxiety subscale |
21 | PedProxAnx45 | Please indicate how often or true the behavior is of your child. | Is overly upset when leaving someone he/she is close to. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Separation anxiety subscale |
22 | PedProxAnx47 | Please indicate how often or true the behavior is of your child. | Is afraid of being away from home. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Separation anxiety subscale |
Sadness | |||||
For the next set of questions, please indicate how often or true the behavior is of your child. | |||||
23 | PedProxDep02 | Please indicate how often or true the behavior is of your child. | Feels worthless or inferior. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Depression subscale |
24 | PedProxDep03 | Please indicate how often or true the behavior is of your child. | Is unhappy, sad or depressed. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Depression subscale |
25 | PedProxDep04 | Please indicate how often or true the behavior is of your child. | Is underactive, slow-moving, or lacks energy. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Depression subscale |
26 | PedProxDep05 | Please indicate how often or true the behavior is of your child. | Cries a lot. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Depression subscale |
27 | PedProxDep06 | Please indicate how often or true the behavior is of your child. | Seems lonely. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Depression subscale |
28 | PedProxDep07 | Please indicate how often or true the behavior is of your child. | Doesn't smile or laugh much. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Depression subscale |
29 | PedProxDep13 | Please indicate how often or true the behavior is of your child. | Withdraws from peer activities. | 0 = Never or not true 1 = Sometimes or somewhat true 2 = Often or very true |
HBQ: MacArthur Health and Behavior Questionnaire: Asocial with peers subscale |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 18+ PA (SELF) | ||||||
Item count | Toolbox ID | Proposed Item Context | Proposed Item Stem | Proposed Responses | Scale | Note |
Postive Feeling States | ||||||
For the next set of questions, please tell us how true each statement was of you in the past 7 days. | ||||||
1 | PA001 | In the past 7 days: | I felt cheerful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
2 | PA002 | In the past 7 days: | I felt attentive. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
3 | PA005 | In the past 7 days: | I felt relaxed. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
4 | PA006 | In the past 7 days: | I felt delighted. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
5 | PA007 | In the past 7 days: | I felt inspired. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
6 | PA008 | In the past 7 days: | I felt fearless. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
8 | PA010 | In the past 7 days: | I felt happy. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
9 | PA014 | In the past 7 days: | I felt joyful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
10 | PA015 | In the past 7 days: | I felt excited. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
11 | PA016 | In the past 7 days: | I felt proud. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
12 | PA017 | In the past 7 days: | I felt lively. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
13 | PA018 | In the past 7 days: | I felt at ease. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
14 | PA019 | In the past 7 days: | I felt enthusiastic. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
15 | PA020 | In the past 7 days: | I felt determined. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
16 | PA021 | In the past 7 days: | I felt interested. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
17 | PA022 | In the past 7 days: | I felt confident. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
18 | PA024 | In the past 7 days: | I felt able to concentrate. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | ||||||
19 | PA025 | In the past 7 days: | I was thinking creatively. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
20 | PA026 | In the past 7 days: | I liked myself. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
21 | PA027 | In the past 7 days: | My future looked good. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
22 | PA029 | In the past 7 days: | I smiled and laughed a lot. | 1= Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
23 | PA030 | In the past 7 days: | I felt peaceful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
FACIT-Sp | |
25 | PA032 | In the past 7 days: | I was able to reach down deep into myself for comfort. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
FACIT-Sp | |
26 | PA033 | In the past 7 days: | I felt a sense of harmony within myself. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
27 | PA034 | In the past 7 days: | I generally enjoyed the things I did. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
28 | PA035 | In the past 7 days: | I felt lighthearted. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
29 | PA036 | In the past 7 days: | I felt satisfied. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
30 | PA037 | In the past 7 days: | I felt good-natured. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
31 | PA039 | In the past 7 days: | I felt useful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
32 | PA040 | In the past 7 days: | I felt optimistic. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
33 | PA041 | In the past 7 days: | I felt interested in other people. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
34 | PA042 | In the past 7 days: | I felt understood. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
34.5 | PA043 | In the past 7 days: | I felt grateful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
||
35 | PA044 | In the past 7 days: | I felt content. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Brief Mood Introspection Scale | |
Life Satisfaction | ||||||
For the next set of questions, please indicate how much you agree or disagree with each statement. | ||||||
36 | PA045 | Indicate how much you agree or disagree: | In most ways my life is close to my ideal. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
37 | PA046 | Indicate how much you agree or disagree: | If I could live my life over, I would change almost nothing. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
38 | PA047 | Indicate how much you agree or disagree: | I am satisfied with my life. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
39 | PA048 | Indicate how much you agree or disagree: | So far I have gotten the important things I want in life. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
40 | PA049 | Indicate how much you agree or disagree: | The conditions of my life are excellent. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
41 | PA045m | Indicate how much you agree or disagree: | In most ways, my life is close to perfect. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | Note: This item was modified from PA045. |
42 | PA049m | Indicate how much you agree or disagree: | My life situation is excellent. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | Note: This item was modified from PA049. |
43 | PA066 | Indicate how much you agree or disagree: | My life is going well. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
44 | PA067 | Indicate how much you agree or disagree: | My life is just right. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
45 | PA068 | Indicate how much you agree or disagree: | I would like to change many things in my life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
46 | PA069 | Indicate how much you agree or disagree: | I wish I had a different kind of life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
47 | PA070 | Indicate how much you agree or disagree: | I have a good life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
48 | PA071 | Indicate how much you agree or disagree: | I have what I want in life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
49 | PA072 | Indicate how much you agree or disagree: | My life is better than most people's lives. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | Note: This item was modified from the kids' version. |
Meaning | ||||||
For the next set of questions, please indicate how much you agree or disagree with each statement. | ||||||
50 | PA051 | Indicate how much you agree or disagree: | My life has a clear sense of purpose. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Meaning in Life Questionnaire (Steger) | |
51 | PA053 | Indicate how much you agree or disagree: | I have discovered a satisfying life purpose. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Meaning in Life Questionnaire (Steger) | |
52 | PA057 | Indicate how much you agree or disagree: | I generally feel that what I do in my life is valuable and worthwhile. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
European Social Survey | |
53 | PA059 | Indicate how much you agree or disagree: | My daily life is full of things that are interesting to me. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
MOS-Mental Health Inventory | |
54 | PA061 | Indicate how much you agree or disagree: | To me, the things I do are all worthwhile. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Life Engagement Test (Scheier) | |
55 | PA063 | Indicate how much you agree or disagree: | I value my activities a lot. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Life Engagement Test (Scheier) | |
56 | PA065 | Indicate how much you agree or disagree: | I have lots of reasons for living. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Life Engagement Test (Scheier) | |
57 | PA075 | Indicate how much you agree or disagree: | I feel a sense of purpose in my life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
FACIT-Sp |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 13-17 PA (SELF) | ||||||
Item Count | Concept ID | Item Context | Item Stem - 13-17 yo SELF | Responses | Scale | Note |
Postive Feeling States | ||||||
For the next set of questions, please tell us how true each statement was of you in the past 7 days. | ||||||
1 | PA001 | In the past 7 days: | I felt cheerful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
2 | PA002 | In the past 7 days: | I felt attentive. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
3 | PA006 | In the past 7 days: | I felt delighted. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
4 | PA009 | In the past 7 days: | I felt calm. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
5 | PA010 | In the past 7 days: | I felt happy. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
6 | PA014 | In the past 7 days: | I felt joyful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
7 | PA018 | In the past 7 days: | I felt at ease. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
8 | PA019 | In the past 7 days: | I felt enthusiastic. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
9 | PA021 | In the past 7 days: | I felt interested. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
10 | PA029 | In the past 7 days: | I smiled and laughed a lot. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
11 | PA030 | In the past 7 days: | I felt peaceful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
FACIT-Sp | |
12 | PA032 | In the past 7 days: | I was able to reach down deep into myself for comfort. | 3 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
FACIT-Sp | |
13 | PA034 | In the past 7 days: | I generally enjoyed the things I did. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Mental Health Inventory | |
14 | PA036 | In the past 7 days: | I felt satisfied. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
15 | PA037 | In the past 7 days: | I felt good-natured. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Affectometer-2 | |
16 | PA044 | In the past 7 days: | I felt content. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
Brief Mood Introspection Scale | |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | ||||||
Life Satisfaction | ||||||
For the next set of questions, please indicate how much you agree or disagree with each statement. | ||||||
17 | PA045 | Indicate how much you agree or disagree: | In most ways my life is close to my ideal. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
18 | PA046 | Indicate how much you agree or disagree: | If I could live my life over, I would change almost nothing. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
19 | PA047 | Indicate how much you agree or disagree: | I am satisfied with my life. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
20 | PA048 | Indicate how much you agree or disagree: | So far I have gotten the important things I want in life. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
21 | PA049 | Indicate how much you agree or disagree: | The conditions of my life are excellent. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | |
22 | PA045m | Indicate how much you agree or disagree: | In most ways, my life is close to perfect. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Satisfaction with Life Scale (Diener) | Note: This item was modified from PA045. |
23 | PA049m | Indicate how much you agree or disagree: | My life situation is excellent. | 1 = Strongly disagree 2 = Disagree 3 = Slightly disagree 4 = Neither agree nor disagree 5 = Slightly agree 6 = Agree 7 = Strongly agree |
Satisfaction with Life Scale (Diener) | Note: This item was modified from PA049. |
24 | PA066 | Indicate how much you agree or disagree: | My life is going well. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
25 | PA067 | Indicate how much you agree or disagree: | My life is just right. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
26 | PA068 | Indicate how much you agree or disagree: | I would like to change many things in my life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
27 | PA069 | Indicate how much you agree or disagree: | I wish I had a different kind of life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
28 | PA070 | Indicate how much you agree or disagree: | I have a good life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
29 | PA071 | Indicate how much you agree or disagree: | I have what I want in life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
30 | PA072m | Indicate how much you agree or disagree: | My life is better than most kids' lives. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
31 | PA103 | Indicate how much you agree or disagree: | I am satisfied with my hobbies and free time activities. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
32 | PA104 | Indicate how much you agree or disagree: | I am satisfied with the clothes, games, toys, and other things I have. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
33 | PA105 | Indicate how much you agree or disagree: | I am satisfied with how much time I get from my parents. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
34 | PA106 | Indicate how much you agree or disagree: | I am satisfied with how much attention I get from my parents. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
35 | PA107 | Indicate how much you agree or disagree: | I am satisfied with how I get along with my brother(s) or sister(s). | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much 6 = Does not apply |
National Survey of Children | |
36 | PA108 | Indicate how much you agree or disagree: | I am satisfied with the friends I have. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
37 | PA109 | Indicate how much you agree or disagree: | I am satisfied with how I get along with my friends. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
38 | PA110 | Indicate how much you agree or disagree: | I am satisfied with my size and appearance. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
39 | PA112 | Indicate how much you agree or disagree: | I am satisfied with my skills and talents. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
40 | PA113 | Indicate how much you agree or disagree: | I am satisfied with the neighborhood and community in which I live. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 8-12 PA (SELF) | |||||
Item Count | Variable Name | Item Context | Item Stem | Responses | Scale |
Postive Feeling States | |||||
For the next set of questions, please tell us how true each statement was of you in the past 7 days. | |||||
1 | PA001 | In the past 7 days: | I felt cheerful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
2 | PA002 | In the past 7 days: | I felt attentive. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
3 | PA005 | In the past 7 days: | I felt relaxed. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
4 | PA006 | In the past 7 days: | I felt delighted. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
5 | PA009 | In the past 7 days: | I felt calm. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
6 | PA010 | In the past 7 days: | I felt happy. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
7 | PA013 | In the past 7 days: | I felt active. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
8 | PA014 | In the past 7 days: | I felt joyful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
9 | PA017 | In the past 7 days: | I felt lively. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
10 | PA018 | In the past 7 days: | I felt at ease. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
11 | PA019 | In the past 7 days: | I felt enthusiastic. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
12 | PA021 | In the past 7 days: | I felt interested. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
13 | PA022 | In the past 7 days: | I felt confident. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
14 | PA023 | In the past 7 days: | I felt energetic. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
15 | PA024 | In the past 7 days: | I felt able to concentrate. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
Directions: For each statement, please select the answer that best describes how true each statement is for you. There are no best answers. People are very different in how they feel about these statements. | |||||
16 | PA099 | I would not be afraid to try a risky sport, like deep-sea diving. | 1 = Almost always untrue of you 2 = Usually untrue of you 3 = Sometimes true, sometimes untrue of you 4 = Usually true of you 5 = Almost always true of you NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised | |
17 | PA100 | I wouldn't be afraid to try something like mountain climbing. | 1 = Almost always untrue of you 2 = Usually untrue of you 3 = Sometimes true, sometimes untrue of you 4 = Usually true of you 5 = Almost always true of you NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised | |
18 | PA118 | I wouldn't be afraid to skateboard or ride a bike really fast down a steep hill. | 1 = Almost always untrue of you 2 = Usually untrue of you 3 = Sometimes true, sometimes untrue of you 4 = Usually true of you 5 = Almost always true of you NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised | |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
19 | PA122 | I like to go high and fast on the swings. | 1 = Almost always untrue of you 2 = Usually untrue of you 3 = Sometimes true, sometimes untrue of you 4 = Usually true of you 5 = Almost always true of you NA = Not applicable |
Temperament in Middle Childhood Questionnaire | |
20 | PA125 | I like going down high slides or other adventurous activities. | 1 = Almost always untrue of you 2 = Usually untrue of you 3 = Sometimes true, sometimes untrue of you 4 = Usually true of you 5 = Almost always true of you NA = Not applicable |
Temperament in Middle Childhood Questionnaire | |
Life Satisfaction | |||||
For the next set of questions, please indicate how much you agree or disagree with each statement. | |||||
21 | PA066 | Indicate how much you agree or disagree: | My life is going well. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
22 | PA067 | Indicate how much you agree or disagree: | My life is just right. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
23 | PA068 | Indicate how much you agree or disagree: | I would like to change many things in my life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
24 | PA069 | Indicate how much you agree or disagree: | I wish I had a different kind of life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
25 | PA070 | Indicate how much you agree or disagree: | I have a good life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
26 | PA071 | Indicate how much you agree or disagree: | I have what I want in life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
27 | PA072m | Indicate how much you agree or disagree: | My life is better than most kids' lives. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
28 | PA103 | Indicate how much you agree or disagree: | I am satisfied with my hobbies and free time activities. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children |
29 | PA104 | Indicate how much you agree or disagree: | I am satisfied with the clothes, games, toys, and other things I have. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children |
30 | PA105 | Indicate how much you agree or disagree: | I am satisfied with how much time I get from my parents. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children |
31 | PA106 | Indicate how much you agree or disagree: | I am satisfied with how much attention I get from my parents. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children |
32 | PA107 | Indicate how much you agree or disagree: | I am satisfied with how I get along with my brother(s) or sister(s). | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much 6 = Does not apply |
National Survey of Children |
33 | PA108 | Indicate how much you agree or disagree: | I am satisfied with the friends I have. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children |
34 | PA109 | Indicate how much you agree or disagree: | I am satisfied with how I get along with my friends. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children |
35 | PA112 | Indicate how much you agree or disagree: | I am satisfied with my skills and talents. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children |
36 | PA113 | Indicate how much you agree or disagree: | I am satisfied with the neighborhood and community in which I live. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 8-12 PA (PROXY) | |||||
Item Count | Concept ID | Item Context | Item Stem | Response | Scale |
Postive Feeling States | |||||
For the next set of questions, please tell us how true the statement was of your child in the past 7 days. | |||||
1 | PAPxy001 | In the past 7 days: | My child was cheerful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
2 | PAPxy002 | In the past 7 days: | My child was attentive. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
3 | PAPxy006 | In the past 7 days: | My child was delighted. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
4 | PAPxy007 | In the past 7 days: | My child was inspired. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
5 | PAPxy010 | In the past 7 days: | My child was happy. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
6 | PAPxy011 | In the past 7 days: | My child was alert. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
7 | PAPxy014 | In the past 7 days: | My child was joyful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
8 | PAPxy015 | In the past 7 days: | My child was excited. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
9 | PAPxy016 | In the past 7 days: | My child was proud. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
10 | PAPxy019 | In the past 7 days: | My child was enthusiastic. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
11 | PAPxy021 | In the past 7 days: | My child was interested. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
12 | PAPxy022 | In the past 7 days: | My child was confident. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
You will see statements that describe children's reactions to different situations. We would like you to tell us what your child's reaction would be in those situations. Select the answer that best describes how true each statement is for your child. If you cannot answer one of the items because you have never seen your child in that situation, then select NA (not applicable). | |||||
13 | PAPxy095 | My child… | Thinks it would be exciting to move to a new city. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised |
14 | PAPxy096 | My child… | Is energized by being in large crowds of people. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised |
15 | PAPxy097 | My child… | Would be frightened by the thought of skiing fast down a steep slope. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised |
16 | PAPxy099 | My child… | Wouldn't be afraid to try a risky sport, like deep-sea diving. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised |
17 | PAPxy100 | My child… | Wouldn't be afraid to try something like mountain climbing. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised |
18 | PAPxy115 | My child… | Would like driving a race car. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised |
19 | PAPxy116 | My child… | Wouldn't want to go on the frightening rides at the fair. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised |
20 | PAPxy117 | My child… | Likes it when something exciting and different happens at school. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised |
21 | PAPxy118 | My child… | Wouldn't be afraid to skateboard or ride a bike really fast down a steep hill. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Early Adolescent Temperament Questionnaire - Revised |
22 | PAPxy119 | My child… | Enjoys exciting and suspenseful TV shows. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Temperament in Middle Childhood Questionnaire |
23 | PAPxy120 | My child… | Likes exploring new places. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Temperament in Middle Childhood Questionnaire |
24 | PAPxy122 | My child… | Likes to go high and fast on the swings. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Temperament in Middle Childhood Questionnaire |
25 | PAPxy123 | My child… | Enjoys playing chase. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Temperament in Middle Childhood Questionnaire |
26 | PAPxy125 | My child… | Likes going down high slides or other adventurous activities. | 1 = Almost always untrue of your child 2 = Usually untrue of your child 3 = Sometimes true, sometimes untrue of your child 4 = Usually true of your child 5 = Almost always true of your child NA = Not applicable |
Temperament in Middle Childhood Questionnaire |
Life Satisfaction | |||||
For the next set of questions, indicate how much you agree or disagree with each statement. | |||||
27 | PAPxy066 | Indicate how much you agree or disagree: | My child's life is going well. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
28 | PAPxy067 | Indicate how much you agree or disagree: | My child's life is just right. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
29 | PAPxy068 | Indicate how much you agree or disagree: | My child would like to change many things in his/her life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
30 | PAPxy069 | Indicate how much you agree or disagree: | My child wishes he/she had a different kind of life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
31 | PAPxy070 | Indicate how much you agree or disagree: | My child has a good life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
32 | PAPxy071 | Indicate how much you agree or disagree: | My child has what he/she wants in life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
33 | PAPxy072 | Indicate how much you agree or disagree: | My child's life is better than most kids' lives. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) |
34 | PAPxy100 | How satisfied is your child with his/her school work? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
35 | PAPxy101 | How satisfied is your child with his/her household chores and responsibilities? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much 6 = Does not apply |
National Survey of Children | |
36 | PAPxy103 | How satisfied is your child with his/her hobbies and free time activities? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
37 | PAPxy104 | How satisfied is your child with the clothes, games, toys, and other things he/she has? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
38 | PAPxy105 | How satisfied is your child with how much time he/she gets from his/her parents? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
39 | PAPxy106 | How satisfied is your child with how much attention he/she gets from his/her parents? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
40 | PAPxy108 | How satisfied is your child with the friends he/she has? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
41 | PAPxy110 | How satisfied is your child with his/her size and appearance? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
42 | PAPxy112 | How satisfied is your child with his/her skills and talents? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
43 | PAPxy113 | How satisfied is your child with the neighborhood and community in which he/she lives? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 3-7 PA (PROXY) | ||||||
Item Count | Concept ID | Item Context | Item Stem | Response | Scale | |
Postive Feeling States | ||||||
For the next set of questions, please tell us how true each statement was of your child in the past 7 days. | ||||||
1 | PAPxy001 | In the past 7 days: | My child was cheerful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
2 | PAPxy006 | In the past 7 days: | My child was delighted. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
3 | PAPxy007 | In the past 7 days: | My child was inspired. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
4 | PAPxy010 | In the past 7 days: | My child was happy. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
5 | PAPxy011 | In the past 7 days: | My child was alert. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
6 | PAPxy014 | In the past 7 days: | My child was joyful. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
7 | PAPxy019 | In the past 7 days: | My child was enthusiastic. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
8 | PAPxy021 | In the past 7 days: | My child was interested. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
9 | PAPxy022 | In the past 7 days: | My child was confident. | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
PANAS-X | |
You will see statements that describe children's reactions to different situations. We would like you to tell us what your child's reaction would be in those situations. Select the answer that best describes how true each statement is for your child. If you cannot answer one of the items because you have never seen your child in that situation, then select NA (not applicable). | ||||||
10 | PAPxy127 | Within the past 6 months, my child... | Enjoys funny stories, but usually doesn't laugh at them. | 1 = Extremely untrue 2 = Quite untrue 3 = Slightly untrue 4 = Neither true nor untrue 5 = Slightly true 6 = Quite true 7 = Extremely true NA = Not applicable |
Children's Behavior Questionnaire - Smiling & Laughter | |
11 | PAPxy129 | Within the past 6 months, my child... | Hardly ever laughs out loud during play with other children. | 1 = Extremely untrue 2 = Quite untrue 3 = Slightly untrue 4 = Neither true nor untrue 5 = Slightly true 6 = Quite true 7 = Extremely true NA = Not applicable |
Children's Behavior Questionnaire - Smiling & Laughter | |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | ||||||
12 | PAPxy133 | Within the past 6 months, my child... | Gets very enthusiastic about the things s/he does. | 1 = Extremely untrue 2 = Quite untrue 3 = Slightly untrue 4 = Neither true nor untrue 5 = Slightly true 6 = Quite true 7 = Extremely true NA = Not applicable |
Children's Behavior Questionnaire - Approach/Positive Anticipation | |
13 | PAPxy136 | Within the past 6 months, my child... | Often laughs out loud in play with other children. | 1 = Extremely untrue 2 = Quite untrue 3 = Slightly untrue 4 = Neither true nor untrue 5 = Slightly true 6 = Quite true 7 = Extremely true NA = Not applicable |
Children's Behavior Questionnaire - Smiling & Laughter | |
14 | PAPxy137 | Within the past 6 months, my child... | Rarely laughs aloud while watching TV or movie comedies. | 1 = Extremely untrue 2 = Quite untrue 3 = Slightly untrue 4 = Neither true nor untrue 5 = Slightly true 6 = Quite true 7 = Extremely true NA = Not applicable |
Children's Behavior Questionnaire - Smiling & Laughter | |
Life Satisfaction | ||||||
For the next set of questions, please indicate how much you agree or disagree with each statement. | ||||||
15 | PAPxy066 | Indicate how much you agree or disagree: | My child's life is going well. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
16 | PAPxy067 | Indicate how much you agree or disagree: | My child's life is just right. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
17 | PAPxy068 | Indicate how much you agree or disagree: | My child would like to change many things in his/her life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
18 | PAPxy069 | Indicate how much you agree or disagree: | My child wishes he/she had a different kind of life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
19 | PAPxy070 | Indicate how much you agree or disagree: | My child has a good life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
20 | PAPxy071 | Indicate how much you agree or disagree: | My child has what he/she wants in life. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
21 | PAPxy072 | Indicate how much you agree or disagree: | My child's life is better than most kids' lives. | 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree |
Students' Life Satisfaction Scale (Huebner) | |
22 | PAPxy100 | How satisfied is your child with his/her school work? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much 6 = Does not apply |
National Survey of Children | ||
23 | PAPxy103 | How satisfied is your child with his/her hobbies and free time activities? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much 6 = Does not apply |
National Survey of Children | ||
24 | PAPxy104 | How satisfied is your child with the clothes, games, toys, and other things he/she has? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | ||
25 | PAPxy106 | How satisfied is your child with how much attention he/she gets from his/her parents? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | ||
26 | PAPxy109 | How satisfied is your child with how he/she gets along with his/her friends? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | ||
27 | PAPxy110 | How satisfied is your child with his/her size and appearance? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | ||
28 | PAPxy112 | How satisfied is your child with his/her skills and talents? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children | ||
29 | PAPxy113 | How satisfied is your child with the neighborhood and community in which he/she lives? | 1 = Not at all 2 = A little bit 3 = Somewhat 4 = Quite a bit 5 = Very much |
National Survey of Children |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 18+ S&SE (SELF) | |||||
Item count | Toolbox ID | Proposed Item Context | Proposed Item Stem | Proposed Responses | Scale |
Perceived Stress | |||||
For the next questions, you will be asked about your feelings and thoughts during the past month. | |||||
1 | SC001 | In the past month… | How often have you been upset because of something that happened unexpectedly? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
2 | SC002 | In the past month… | How often have you felt that you were unable to control the important things in your life? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
3 | SC003 | In the past month… | How often have you felt nervous and “stressed”? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
4 | SC004 | In the past month… | How often have you dealt successfully with day to day problems and annoyances? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
5 | SC005 | In the past month… | How often have you felt that you were effectively coping with important changes that were occurring in your life? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
6 | SC006 | In the past month… | How often have you felt confident about your ability to handle your personal problems? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
7 | SC007 | In the past month… | Hhow often have you felt that things were going your way? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
8 | SC008 | In the past month… | How often have you found that you could not cope with all the things that you had to do? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
9 | SC009 | In the past month… | How often have you been able to control irritations in your life? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
10 | SC010 | In the past month… | How often have you felt that you were on top of things? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
11 | SC011 | In the past month… | How often have you been angered because of things that happened that were outside of your control? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
12 | SC012 | In the past month… | How often have you found yourself thinking about things that you have to accomplish? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
13 | SC013 | In the past month… | How often have you been able to control the way you spend your time? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
14 | SC014 | In the past month… | How often have you felt difficulties were piling up so high that you could not overcome them? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
PSS-14 |
15 | SC004m | In the past month… | How often have you dealt successfully with day to day problems and things that bother you? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
Coping Self-Efficacy | |||||
For the next set of questions, please read each sentence and decide how true it is of you in general. | |||||
16 | GSE01 | Please read the sentence and decide how true it is of you in general. | I can always manage to solve difficult problems if I try hard enough. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
17 | GSE02 | Please read the sentence and decide how true it is of you in general. | If someone opposes me, I can find the means and ways to get what I want. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
18 | GSE03 | Please read the sentence and decide how true it is of you in general. | It is easy for me to stick to my aims and accomplish my goals. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
19 | GSE04 | Please read the sentence and decide how true it is of you in general. | I am confident that I could deal efficiently with unexpected events. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
20 | GSE05m | Please read the sentence and decide how true it is of you in general. | Thanks to my talents and skills, I know how to handle unexpected situations. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
21 | GSE06m | Please read the sentence and decide how true it is of you in general. | I can solve most problems if I try hard enough. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
22 | GSE07m | Please read the sentence and decide how true it is of you in general. | I stay calm when facing difficulties because I can handle them. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
23 | GSE08m | Please read the sentence and decide how true it is of you in general. | When I have a problem, I can usually find several ways to solve it. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
24 | GSE09 | Please read the sentence and decide how true it is of you in general. | If I am in trouble, I can usually think of a solution. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
25 | GSE10 | Please read the sentence and decide how true it is of you in general. | I can usually handle whatever comes my way. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES |
Coping Self-Efficacy | |||||
For the next set of questions, please read each sentence and decide how true it is of you in general. | |||||
26 | SC051 | Please read the sentence and decide how true it is of you in general. | I can always manage to solve difficult problems if I try hard enough. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
27 | SC052 | Please read the sentence and decide how true it is of you in general. | If someone opposes me, I can find the means and ways to get what I want. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
28 | SC053 | Please read the sentence and decide how true it is of you in general. | It is easy for me to stick to my aims and accomplish my goals. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
29 | SC054 | Please read the sentence and decide how true it is of you in general. | I am confident that I could deal efficiently with unexpected events. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
30 | SC055 | Please read the sentence and decide how true it is of you in general. | Thanks to my resourcefulness, I know how to handle unforeseen situations. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
31 | SC056 | Please read the sentence and decide how true it is of you in general. | I can solve most problems if I invest the necessary effort. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
32 | SC057 | Please read the sentence and decide how true it is of you in general. | I can remain calm when facing difficulties because I can rely on my coping abilities. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
33 | SC058 | Please read the sentence and decide how true it is of you in general. | When I am confronted with a problem, I can usually find several solutions. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
34 | SC059 | Please read the sentence and decide how true it is of you in general. | If I am in trouble, I can usually think of a solution. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
35 | SC060 | Please read the sentence and decide how true it is of you in general. | I can usually handle whatever comes my way. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 13-17 S&SE (SELF) | |||||
Item Count | Concept ID | Item Context | Item Stem - 13-17 yo SELF | Responses | Scale |
Perceived Stress | |||||
For the next questions, you will be asked about your feelings and thoughts during the past month. | |||||
1 | SC001 | In the past month… | How often have you been upset because of something that happened unexpectedly? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
2 | SC002 | In the past month… | How often have you felt that you were unable to control the important things in your life? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
3 | SC003 | In the past month… | How often have you felt nervous and “stressed”? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
4 | SC004m | In the past month… | How often have you dealt successfully with day to day problems and things that bother you? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
5 | SC005m | In the past month… | How often have you felt that you were effectively handling important changes that were occurring in your life? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
6 | SC006 | In the past month… | How often have you felt confident about your ability to handle your personal problems? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
7 | SC007 | In the past month… | How often have you felt that things were going your way? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
8 | SC008m | In the past month… | How often have you found that you could not handle (OR manage) all the things that you had to do? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
9 | SC009 | In the past month… | How often have you been able to control irritations in your life? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
10 | SC010 | In the past month… | How often have you felt that you were on top of things? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
11 | SC011 | In the past month… | How often have you been angered because of things that happened that were outside of your control? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
12 | SC012 | In the past month… | How often have you found yourself thinking about things that you have to accomplish? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
13 | SC013 | In the past month… | How often have you been able to control the way you spend your time? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
14 | SC014 | In the past month… | How often have you felt difficulties were piling up so high that you could not overcome them? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
Self-Efficacy | |||||
For the next set of questions, please read each sentence and decide how true it is of you in general. | |||||
15 | GSE01 | Please read the sentence and decide how true it is of you in general. | I can always manage to solve difficult problems if I try hard enough. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES01 |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
16 | GSE02m | Please read the sentence and decide how true it is of you in general. | If someone tries to keep me from getting what I want, I can find a way to get what I want. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES02 |
17 | GSE03m | Please read the sentence and decide how true it is of you in general. | It is easy for me to stick to my goals and reach them. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES03 |
18 | GSE04m | Please read the sentence and decide how true it is of you in general. | I am confident that I could do a good job dealing with unexpected events. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES04 |
19 | GSE05m | Please read the sentence and decide how true it is of you in general. | Thanks to my talents and skills, I know how to handle unexpected situations. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES05 |
20 | GSE06m | Please read the sentence and decide how true it is of you in general. | I can solve most problems if I try hard enough. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES06 |
21 | GSE07m | Please read the sentence and decide how true it is of you in general. | I can stay calm when facing difficulties because I can handle them. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES07 |
22 | GSE08m | Please read the sentence and decide how true it is of you in general. | When I have a problem, I can usually find several ways to solve it. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES08 |
23 | GSE09 | Please read the sentence and decide how true it is of you in general. | If I am in trouble, I can usually think of a solution. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES09 |
24 | GSE10 | Please read the sentence and decide how true it is of you in general. | I can usually handle whatever comes my way. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES10 |
For the next set of questions, please read each sentence and decide how true it was of you in the past month. | |||||
25 | HIF03 | In the past month… | I was in control of how often I felt mad. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
26 | HIF06 | In the past month… | When I felt happy, I could control or change how happy I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
27 | HIF09 | In the past month… | I was in control of how often I felt excited. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
28 | HIF12 | In the past month… | When I felt sad, I could control or change how sad I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
29 | HIF15 | In the past month… | I was in control of how often I felt scared. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
30 | HIF18 | In the past month… | When I felt mad, I could control or change how mad I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
31 | HIF21 | In the past month… | I was in control of how often I felt happy. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
32 | HIF24 | In the past month… | When I felt excited, I could control or change how excited I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
33 | HIF27 | In the past month… | I was in control of how often I felt sad. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
34 | HIF30 | In the past month… | When I felt scared, I could control or change how scared I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
For the next set of questions, please read each sentence and decide how true it is of you in general. | |||||
35 | SC051 | Please read the sentence and decide how true it is of you in general. | I can always manage to solve difficult problems if I try hard enough. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES01 |
36 | SC052m | Please read the sentence and decide how true it is of you in general. | If someone tries to keep me from getting what I want, I can find a way to get what I want. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES02 |
37 | SC053m | Please read the sentence and decide how true it is of you in general. | It is easy for me to stick to my goals and reach them. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES03 |
38 | SC054m | Please read the sentence and decide how true it is of you in general. | I am confident that I could do a good job dealing with unexpected events. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES04 |
39 | SC055m | Please read the sentence and decide how true it is of you in general. | Thanks to my talents and skills, I know how to handle unexpected situations. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES05 |
40 | SC056m | Please read the sentence and decide how true it is of you in general. | I can solve most problems if I try hard enough. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES06 |
41 | SC057 | Please read the sentence and decide how true it is of you in general. | I can remain calm when facing difficulties because I can rely on my coping abilities. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES07 |
42 | SC058m | Please read the sentence and decide how true it is of you in general. | When I have a problem, I can usually find several ways to solve it. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES08 |
43 | SC059 | Please read the sentence and decide how true it is of you in general. | If I am in trouble, I can usually think of a solution. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES09 |
44 | SC060 | Please read the sentence and decide how true it is of you in general. | I can usually handle whatever comes my way. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES10 |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 8-12 S&SE (SELF) | |||||
Item Count | Variable Name | Item Context | Item Stem | Responses | Scale |
Perceived Stress | |||||
For the next questions, you will be asked about your feelings and thoughts during the past month. | |||||
1 | SC001m2 | In the past month… | How often have you been upset when something happened that you didn't expect? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
2 | SC002m | In the past month… | How often have you felt that you could not control something important to you? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
3 | SC003 | In the past month… | How often have you felt nervous and “stressed”? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
4 | SC004m | In the past month… | How often have you dealt successfully with day to day problems and things that bother you? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
5 | SC005m2 | In the past month… | How often have you felt that you were able to handle things that changed in your life? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
6 | SC006m | In the past month… | How often have you felt like you could handle your personal problems? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
7 | SC007 | In the past month… | How often have you felt that things were going your way? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
8 | SC008m | In the past month… | How often have you found that you could not handle (OR manage) all the things that you had to do? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
9 | SC009m | In the past month… | How often have you been able to calm yourself down when you get upset? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
10 | SC010m | In the past month… | How often have you felt like things were going well for you? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
11 | SC011m | In the past month… | How often did you get mad because you couldn't do something? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
12 | SC012m | In the past month… | How often have you found yourself thinking about things that you have to do? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
13 | SC013m | In the past month… | How often have you been able to decide how you spend your time? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
14 | SC014m | In the past month… | How often have you felt like things were getting worse and worse for you? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
Self-Efficacy | |||||
For the next set of questions, please read each sentence and decide how true it is of you in general. | |||||
15 | GSE01 | Please read the sentence and decide how true it is of you in general. | I can always manage to solve difficult problems if I try hard enough. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES01 |
16 | GSE02m | Please read the sentence and decide how true it is of you in general. | If someone tries to keep me from getting what I want, I can find a way to get what I want. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES02 |
17 | GSE03m | Please read the sentence and decide how true it is of you in general. | It is easy for me to stick to my goals and reach them. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES03 |
18 | GSE04m | Please read the sentence and decide how true it is of you in general. | I am confident that I could do a good job dealing with unexpected events. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES04 |
19 | GSE05m | Please read the sentence and decide how true it is of you in general. | Thanks to my talents and skills, I know how to handle unexpected situations. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES05 |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
20 | GSE06m | Please read the sentence and decide how true it is of you in general. | I can solve most problems if I try hard enough. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES06 |
21 | GSE07m | Please read the sentence and decide how true it is of you in general. | I can stay calm when facing difficulties because I can handle them. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES07 |
22 | GSE08m | Please read the sentence and decide how true it is of you in general. | When I have a problem, I can usually find several ways to solve it. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES08 |
23 | GSE09 | Please read the sentence and decide how true it is of you in general. | If I am in trouble, I can usually think of a solution. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES09 |
24 | GSE10 | Please read the sentence and decide how true it is of you in general. | I can usually handle whatever comes my way. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES10 |
For the next set of questions, please read each sentence and decide how true it was of you in the past month. | |||||
25 | HIF03 | In the past month… | I was in control of how often I felt mad. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
26 | HIF06 | In the past month… | When I felt happy, I could control or change how happy I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
27 | HIF09 | In the past month… | I was in control of how often I felt excited. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
28 | HIF12 | In the past month… | When I felt sad, I could control or change how sad I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
29 | HIF15 | In the past month… | I was in control of how often I felt scared. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
30 | HIF18 | In the past month… | When I felt mad, I could control or change how mad I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
31 | HIF21 | In the past month… | I was in control of how often I felt happy. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
32 | HIF24 | In the past month… | When I felt excited, I could control or change how excited I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
33 | HIF27 | In the past month… | I was in control of how often I felt sad. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
34 | HIF30 | In the past month… | When I felt scared, I could control or change how scared I felt. | 1 = Not at all true of me 2 = A little true of me 3 = Somewhat true of me 4 = Pretty true of me 5 = Very true of me |
How I Feel |
For the next set of questions, please read each sentence and decide how true it is of you in general. | |||||
35 | SC051 | Please read the sentence and decide how true it is of you in general. | I can always manage to solve difficult problems if I try hard enough. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES01 |
36 | SC052m | Please read the sentence and decide how true it is of you in general. | If someone tries to keep me from getting what I want, I can find a way to get what I want. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES02 |
37 | SC053m | Please read the sentence and decide how true it is of you in general. | It is easy for me to stick to my goals and reach them. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES03 |
38 | SC054m | Please read the sentence and decide how true it is of you in general. | I am confident that I could do a good job dealing with unexpected events. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES04 |
39 | SC055m | Please read the sentence and decide how true it is of you in general. | Thanks to my talents and skills, I know how to handle unexpected situations. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES05 |
40 | SC056m | Please read the sentence and decide how true it is of you in general. | I can solve most problems if I try hard enough. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES06 |
41 | SC057m | Please read the sentence and decide how true it is of you in general. | I can stay calm when facing difficulties because I can handle them. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES07 |
42 | SC058m | Please read the sentence and decide how true it is of you in general. | When I have a problem, I can usually find several ways to solve it. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES08 |
43 | SC059 | Please read the sentence and decide how true it is of you in general. | If I am in trouble, I can usually think of a solution. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES09 |
44 | SC060 | Please read the sentence and decide how true it is of you in general. | I can usually handle whatever comes my way. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES10 |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 8-12 S&SE (PROXY) | |||||
Item Count | ID # | Item Context | Item Stem | Responses | Scale |
Perceived Stress | |||||
For the next questions, you will be asked about your child’s feelings and thoughts during the past month. | |||||
1 | SCPxy001m | In the past month… | How often was your child upset because of something that happened unexpectedly? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
2 | SCPxy002m | In the past month… | How often did your child appear frustrated by being unable to control or do something? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
3 | SCPxy003 | In the past month… | How often did your child appear nervous and “stressed”? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
4 | SCPxy004m | In the past month… | How often did your child deal successfully with day to day problems and annoyances? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
5 | SCPxy005m | In the past month… | How often did your child seem to cope effectively with important changes that were occurring? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
6 | SCPxy006m | In the past month… | How often did your child appear confident about his or her ability to handle personal problems? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
7 | SCPxy007m | In the past month… | How often did your child seem to feel things were going well? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
8 | SCPxy008m | In the past month… | How often did your child seem unable to cope with all the things that had to be done? |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
9 | SCPxy009m | In the past month… | How often did your child seem able to control life's irritations? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
10 | SCPxy010m | In the past month… | How often did it seem that life was going well for your child? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
11 | SCPxy011m | In the past month… | How often did your child appear angered by things that happened outside of his/her control? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
12 | SCPxy012m | In the past month… | How often did your child appear to be thinking about things that had to be done? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
13 | SCPxy013m | In the past month… | How often could your child choose how to spend spare time? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
14 | SCPxy014m | In the past month… | How often did difficulties pile up so high that your child did not seem able to overcome them? | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
MODIFIED PSS-14 |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
Coping Self-Efficacy | |||||
For the next set of questions, please read each sentence and decide how true it is of your child in general. | |||||
15 | PxyGSE01 | Please read the sentence and decide how true it is of your child in general. | Your child seems to believe that he/she can always manage to solve difficult problems if he/she tries hard enough. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES01 |
16 | PxyGSE02m | Please read the sentence and decide how true it is of your child in general. | If someone opposes your child, he/she can find the means and ways to get what he/she wants. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES02 |
17 | PxyGSE03m | Please read the sentence and decide how true it is of your child in general. | It is easy for your child to stick to his/her goals and reach them. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES03 |
18 | PxyGSE04m | Please read the sentence and decide how true it is of your child in general. | Your child appears confident that he/she could do a good job dealing with unexpected events. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES04 |
19 | PxyGSE05m | Please read the sentence and decide how true it is of your child in general. | Thanks to your child's talents and skills, he/she knows how to handle unexpected situations. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES05 |
20 | PxyGSE06m | Please read the sentence and decide how true it is of your child in general. | Your child believes he/she can solve most problems if he/she tries hard enough. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES06 |
21 | PxyGSE07m | Please read the sentence and decide how true it is of your child in general. | Your child can remain calm when facing difficulties because he/she can rely on his/her coping abilities. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES07 |
22 | PxyGSE08m | Please read the sentence and decide how true it is of your child in general. | When your child is confronted with a problem, he/she can usually find several solutions. |
1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES08 |
23 | PxyGSE09 | Please read the sentence and decide how true it is of your child in general. | If your child is in trouble, he/she can usually think of a solution. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES09 |
24 | PxyGSE10 | Please read the sentence and decide how true it is of your child in general. | Your child can usually handle whatever comes his/her way. | 1 = Never 2 = Almost Never 3 = Sometimes 4 = Fairly Often 5 = Very Often |
mGSES10 |
For the next set of questions, please read each sentence and decide how true it was of your child in the past month. | |||||
25 | PedHIF03 | In the past month… | Your child was in control of how often he/she felt mad. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
26 | PedHIF06 | In the past month… | When your child felt happy, he/she could control or change how happy he/she felt. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
27 | PedHIF09 | In the past month… | Your child was in control of how often he/she felt excited. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
28 | PedHIF12 | In the past month… | When your child felt sad, he/she could control or change how sad he/she felt. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
29 | PedHIF15 | In the past month… | Your child was in control of how often he/she felt scared. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
30 | PedHIF18 | In the past month… | When your child felt mad, he/she could control or change how mad he/she felt. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
31 | PedHIF21 | In the past month… | Your child appeared in control of how often he/she felt happy. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
32 | PedHIF24 | In the past month… | When your child felt excited, he/she appeared in control of how excited he/she felt. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
33 | PedHIF27 | In the past month… | Your child appeared in control of how often he/she felt sad. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
34 | PedHIF30 | In the past month… | When your child felt scared, he/she appeared in control of how scared he/she felt. | 1 = Not at all true of your child 2 = A little true of your child 3 = Somewhat true of your child 4 = Pretty true of your child 5 = Very true of your child |
How I Feel |
For the next set of questions, please read each sentence and decide how true it is of your child in general. | |||||
35 | PedSC051 | Please read the sentence and decide how true it is of your child in general. | Your child seems to believe that he/she can always manage to solve difficult problems if he/she tries hard enough. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES01 |
36 | PedSC052m | Please read the sentence and decide how true it is of your child in general. | If someone opposes your child, he/she can find the means and ways to get what he/she wants. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES02 |
37 | PedSC053m | Please read the sentence and decide how true it is of your child in general. | It is easy for your child to stick to his/her goals and reach them. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES03 |
38 | PedSC054m | Please read the sentence and decide how true it is of your child in general. | Your child appears confident that he/she could do a good job dealing with unexpected events. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES04 |
39 | PedSC055m | Please read the sentence and decide how true it is of your child in general. | Thanks to your child's talents and skills, he/she knows how to handle unexpected situations. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES05 |
40 | PedSC056m | Please read the sentence and decide how true it is of your child in general. | Your child believes he/she can solve most problems if he/she tries hard enough. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES06 |
41 | PedSC057m | Please read the sentence and decide how true it is of your child in general. | Your child can remain calm when facing difficulties because he/she can rely on his/her coping abilities. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES07 |
42 | PedSC058m | Please read the sentence and decide how true it is of your child in general. | When your child is confronted with a problem, he/she can usually find several solutions. |
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES08 |
43 | PedSC059 | Please read the sentence and decide how true it is of your child in general. | If your child is in trouble, he/she can usually think of a solution. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES09 |
44 | PedSC060 | Please read the sentence and decide how true it is of your child in general. | Your child can usually handle whatever comes his/her way. | 1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true |
GSES10 |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 18+ SR (SELF) | |||||
Item Count | ID # | Item Context | Item Stem | Responses | Scale |
Social Support - Emotional Support | |||||
The next questions refer to people in your daily life. This may include family members, friends, neighbors, or others you see regularly such as those at work or school. Please read each statement and describe how often each has occurred in the past month. | |||||
1 | SOC200 | In the past month, please describe how often… | I have someone who understands my problems. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Emotional |
2 | SOC203 | In the past month, please describe how often… | I have someone who will listen to me when I need to talk. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Emotional |
3 | SOC204 | In the past month, please describe how often… | I feel there are people I can talk to if I am upset. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Emotional |
4 | SOC205 | In the past month, please describe how often… | I have someone to talk with when I have a bad day. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Emotional |
5 | SOC206 | In the past month, please describe how often… | I have someone I trust to talk with about my problems. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Emotional |
6 | SOC207 | In the past month, please describe how often… | I have someone I trust to talk with about my feelings. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Emotional |
7 | SOC222 | In the past month, please describe how often… | I can get helpful advice from others when dealing with a problem. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Informational |
8 | SOC229 | In the past month, please describe how often… | I have someone to turn to for suggestions about how to deal with a problem. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Informational |
Social Support - Instrumental Support | |||||
9 | SOC210 | In the past month, please describe how often… | Someone is around to make my meals if I am unable to do it myself. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Instrumental |
10 | SOC212 | In the past month, please describe how often… | I have someone to take me shopping if I need it. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Instrumental |
11 | SOC213 | In the past month, please describe how often… | I have someone to help me if I'm sick in bed. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Instrumental |
12 | SOC214 | In the past month, please describe how often… | I have someone to pick up medicine for me if I need it. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Instrumental |
13 | SOC215 | In the past month, please describe how often… | I have someone to take me to the doctor if I need it. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Instrumental |
14 | SOC216 | In the past month, please describe how often… | There is someone around to help me if I need it. | 1 - Never 2 - Rarely 3 - Sometimes 4 - Usually 5 - Always |
Social Support - Instrumental |
15 | SOC217 | In the past month, please describe how often… | I can find someone to drive me places if I need it. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Instrumental |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
16 | SOC218 | In the past month, please describe how often… | I can get help cleaning up around my home if I need it. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Support - Instrumental |
Companionship - Friendship | |||||
The next questions refer to people in your daily life. This may include family members, friends, neighbors, or others you see regularly such as those at work or school. Please read each statement and describe how often each has occurred in the past month. | |||||
17 | SOC230 | In the past month, please describe how often… | I get invited to go out and do things with other people. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness - Companionship |
18 | SOC231 | In the past month, please describe how often… | I have friends I get together with to relax. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness - Companionship |
19 | SOC232 | In the past month, please describe how often… | There are people around with whom to have fun. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness - Companionship |
20 | SOC233 | In the past month, please describe how often… | I can find a friend when I need one. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness - Companionship |
21 | SOC237 | In the past month, please describe how often… | I feel like I have lots of friends. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness - Companionship |
22 | SOC239 | In the past month, please describe how often… | I have friends who will have lunch with me when I want. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness - Companionship |
23 | SOC246 | In the past month, please describe how often… | I feel close to my friends. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness - Intimacy/Connectedness |
24 | SOC247 | In the past month, please describe how often… | I feel like I'm part of a group of friends. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness - Intimacy/Connectedness |
Companionship - Loneliness | |||||
25 | SOC253 | In the past month, please describe how often… | I feel alone and apart from others. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness- Loneliness items |
26 | SOC254 | In the past month, please describe how often… | I feel left out. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness- Loneliness items |
27 | SOC255 | In the past month, please describe how often… | I feel that I am no longer close to anyone. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness- Loneliness items |
28 | SOC260 | In the past month, please describe how often… | I feel alone. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness- Loneliness items |
29 | SOC261 | In the past month, please describe how often… | I feel lonely. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness- Loneliness items |
Social Distress - Perceived Rejection/Insensitivity | |||||
The next questions refer to people in your daily life. This may include family members, friends, neighbors, or others you see regularly such as those at work or school. Please read each statement and describe how often each has occurred in the past month. | |||||
30 | SOC275 | In the past month, please describe how often people in your life… | Don't listen when I ask for help. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Insensitivity/Neglect |
31 | SOC276 | In the past month, please describe how often people in your life… | Act like my problems aren't that important. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Insensitivity/Neglect |
32 | SOC277 | In the past month, please describe how often people in your life… | Let me down when I am counting on them. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Insensitivity/Neglect |
33 | SOC279 | In the past month, please describe how often people in your life… | Act like they don't have time for me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Insensitivity/Neglect |
34 | SOC280 | In the past month, please describe how often people in your life… | Act like they don't want to hear about my problems. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Insensitivity/Neglect |
35 | SOC281 | In the past month, please describe how often people in your life… | Act like they don't care about me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Insensitivity/Neglect |
36 | SOC282 | In the past month, please describe how often people in your life… | Act like they can't be bothered by me or my problems. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Insensitivity/Neglect |
37 | SOC286 | In the past month, please describe how often people in your life… | Avoid talking to me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Rejection/Ridicule |
Social Distress - Perceived Hostility | |||||
38 | SOC262 | In the past month, please describe how often people in your life… | Argue with me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Hostility/Criticism |
39 | SOC263 | In the past month, please describe how often people in your life… | Act in an angry way toward me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Hostility/Criticism |
40 | SOC264 | In the past month, please describe how often people in your life… | Criticize the way I do things. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Hostility/Criticism |
41 | SOC267 | In the past month, please describe how often people in your life… | Yell at me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Hostility/Criticism |
42 | SOC268 | In the past month, please describe how often people in your life… | Get mad at me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Hostility/Criticism |
43 | SOC270 | In the past month, please describe how often people in your life… | Blame me when things go wrong. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Hostility/Criticism |
44 | SOC271 | In the past month, please describe how often people in your life… | Act nasty to me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Hostility/Criticism |
45 | SOC288 | In the past month, please describe how often people in your life… | Tease me in a mean way. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Social Distress - Rejection/Ridicule |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 8-17 SR (SELF) | |||||
Item Count | ID # | Item Context | Item Stem | Responses | Scale |
Social Support - Emotional Support | |||||
The next questions refer to people in your daily life. This may include family members, friends, neighbors, or others you see regularly such as those at work or school. Please read each statement and describe how often each has occurred in the past month. | |||||
1 | SOC200 | In the past month, please describe how often… | I have someone who understands my problems. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Emotional Support |
2 | SOC203 | In the past month, please describe how often… | I have someone who will listen to me when I need to talk. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Emotional Support |
3 | SOC205 | In the past month, please describe how often… | I have someone to talk with when I have a bad day. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Emotional Support |
4 | SOC216 | In the past month, please describe how often… | There is someone around to help me if I need it. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Emotional Support |
5 | SOC222 | In the past month, please describe how often… | I can get helpful advice from others when dealing with a problem. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Emotional Support |
6 | SOC225 | In the past month, please describe how often… | I get useful advice about important things in my life. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Emotional Support |
7 | SOC226 | In the past month, please describe how often… | I have someone to talk with about school problems. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Emotional Support |
Social Support - Parental Relationships | |||||
Relationship with Mother | |||||
8 | PedsSS06 | In the past month, please describe … | How often you and your mother do things together that you enjoy. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always 6 = I have not seen or talked to my mother in the last month |
NSC - National Survey of Children |
9 | PedsSS07 | In the past month, please describe … | How often you and your mother share ideas and talk about things that really matter. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always 6 = I have not seen or talked to my mother in the last month |
NSC - National Survey of Children |
10 | PedsSS08 | In the past month, please describe … | How close you feel to your mother. | 1 = Extremely close 2 = Quite close 3 = Fairly close 4 = Not very close |
NSC - National Survey of Children |
Relationship with Father | |||||
11 | PedsSS15 | In the past month, please describe … | How often you and your father do things together that you enjoy. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always 6 = I have not seen or talked to my father in the last month |
NSCH - National Survey of Children |
12 | PedsSS16 | In the past month, please describe … | How often you and your father share ideas and talk about things that really matter. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always 6 = I have not seen or talked to my father in the last month |
NSCH - National Survey of Children |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
13 | PedsSS17 | In the past month, please describe … | How close you feel to your father. | 1 = Extremely close 2 = Quite close 3 = Fairly close 4 = Not very close |
NSCH - National Survey of Children |
Companionship - Friendship | |||||
The next questions refer to people in your daily life. This may include family members, friends, neighbors, or others you see regularly such as those at work or school. Please read each statement and describe how often each has occurred in the past month. | |||||
14 | SOC230 | In the past month, please describe how often… | I get invited to go out and do things with other people. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Friendship |
15 | SOC233 | In the past month, please describe how often… | I can find a friend when I need one. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Friendship |
16 | SOC237 | In the past month, please describe how often… | I feel like I have lots of friends. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Friendship |
17 | SOC239m | In the past month, please describe how often… | I have friends to sit with at lunch. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Friendship |
18 | SOC247 | In the past month, please describe how often… | I feel like I'm part of a group of friends. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Friendship |
Companionship - Loneliness | |||||
19 | SOC252 | In the past month, please describe how often… | I feel that I have nobody to talk to. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness |
20 | SOC253 | In the past month, please describe how often… | I feel alone and apart from others. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness |
21 | SOC254 | In the past month, please describe how often… | I feel left out. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness |
22 | SOC258 | In the past month, please describe how often… | I feel that I don't have any friends. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness |
23 | SOC259 | In the past month, please describe how often… | I feel that there is no one I can go to when I need help. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness |
24 | SOC260 | In the past month, please describe how often… | I feel alone. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness |
25 | SOC261 | In the past month, please describe how often… | I feel lonely. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Loneliness |
Social Distress - Perceived Hostility | |||||
The next questions refer to people in your daily life. This may include family members, friends, neighbors, or others you see regularly such as those at work or school. Please read each statement and describe how often each has occurred in the past month. | |||||
26 | SOC262 | In the past month, please describe how often people in your life… | Argue with me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Perceived Hostility |
27 | SOC263 | In the past month, please describe how often people in your life… | Act in an angry way toward me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Perceived Hostility |
28 | SOC267 | In the past month, please describe how often people in your life… | Yell at me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Perceived Hostility |
29 | SOC268 | In the past month, please describe how often people in your life… | Get mad at me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Perceived Hostility |
30 | SOC270 | In the past month, please describe how often people in your life… | Blame me when things go wrong. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Perceived Hostility |
Social Distress - Perceived Rejection/Insensitivity | |||||
31 | SOC276 | In the past month, please describe how often people in your life… | Act like my problems aren't that important. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Insensitivity/Ridicule |
32 | SOC279 | In the past month, please describe how often people in your life… | Act like they don't have time for me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Insensitivity/Ridicule |
33 | SOC281 | In the past month, please describe how often people in your life… | Act like they don't care about me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Insensitivity/Ridicule |
34 | SOC283 | In the past month, please describe how often people in your life… | Put me down. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Insensitivity/Ridicule |
35 | SOC287 | In the past month, please describe how often people in your life… | Make me feel like I don't fit in. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Insensitivity/Ridicule |
36 | SOC288 | In the past month, please describe how often people in your life… | Tease me in a mean way. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Insensitivity/Ridicule |
37 | SOC289 | In the past month, please describe how often people in your life… | Make fun of me. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
Insensitivity/Ridicule |
EMOTIONAL HEALTH QUESTIONNAIRES FOR TOOLBOX, 3-12 SR (PROXY) | |||||
Item Count | ID # | Item Context | Item Stem | Responses | Scale |
Positive Parental Relationships | |||||
For the next set of questions, please read each statement and then decide how much each applies to your child in the past month. | |||||
1 | PedPxySS01 | In the past month… | Your relationship with your child was | 1 = Very warm and close 2 = Somewhat warm and close 3 = Somewhat distant 4 = Very distant |
NSCH - National Survey of Children's Health: Parent Support |
2 | PedPxySS02 | In the past month, please describe… | How often your child is affectionate or tender with you. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
NSCH - National Survey of Children's Health: Parent Support |
3 | PedPxySS03 | In the past month, please describe… | How often you feel that you can really trust your child. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
NSCH - National Survey of Children's Health: Parent Support |
4 | PedPxySS04 | In the past month, please describe… | How well you and your child share ideas or talk about things that really matter. | 1 = Very well 2 = Somewhat well 3 = Not very well 4 = Not well at all |
NSCH - National Survey of Children's Health: Parent Support |
5 | PedPxySS05 | In the past month, please describe… | How often you and your child make decisions together. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
NSCH - National Survey of Children's Health: Parent Support |
Negative Parental Relationships | |||||
6 | PedPxySD21 | In the past month, please describe… | How often you have felt your child is harder to care for than most children his/her age. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
NSCH - National Survey of Children's Health: Parenting Stress |
7 | PedPxySD22 | In the past month, please describe… | How often you have felt your child does things that really bother you a lot. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
NSCH - National Survey of Children's Health: Parenting Stress |
8 | PedPxySD23 | In the past month, please describe… | How often you have felt angry with your child. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
NSCH - National Survey of Children's Health: Parenting Stress |
9 | PedPxySD24 | In the past month, please describe… | How often you have felt that you did not understand your child. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
NSCH - National Survey of Children's Health: Parenting Stress |
Companionship - Social Withdrawal | |||||
For the next set of questions, please read each statement and then decide how much each applies to your child in the past month. | |||||
10 | PedPxyLon01 | In the past month, please describe… | How often your child is solitary. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Asocial with peers |
11 | PedPxyLon04 | In the past month, please describe… | How often your child avoids peers. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Asocial with peers |
12 | PedPxyLon05 | In the past month, please describe… | How often your child keeps peers at a distance. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Asocial with peers |
13 | PedPxyLon06 | In the past month, please describe… | How often your child withdraws from peer activities. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Asocial with peers |
Companionship - Positive Peer Interactions | |||||
14 | PedPxySS08 | In the past month, please describe… | How often your child plays with friends. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (support) |
Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address. | |||||
15 | PedPxySS09 | In the past month, please describe… | How often your child gets along with peers of the same sex. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (support) |
16 | PedPxySS10 | In the past month, please describe… | How often other children seek your child out for play. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (support) |
17 | PedPxySS11 | In the past month, please describe… | How often your child gets along with peers of the opposite sex. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (support) |
Social Distress - Rejection by Peers | |||||
For the next set of questions, please read each statement and then decide how much each applies to your child in the past month. | |||||
18 | PedPxySD01 | In the past month, please describe… | How often your child is left out by other children. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (rejection) |
19 | PedPxySD02 | In the past month, please describe… | How often other children refuse to let your child play with them. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (rejection) |
20 | PedPxySD03 | In the past month, please describe… | How often your child is not chosen as a playmate. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (rejection) |
21 | PedPxySD04 | In the past month, please describe… | How often your child is actively rejected by other children who refuse to play with him/her. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (rejection) |
22 | PedPxySD05 | In the past month, please describe… | How often your child is avoided by other children. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (rejection) |
23 | PedPxySD06 | In the past month, please describe… | How often your child is not well liked by other children. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (rejection) |
24 | PedPxySD07 | In the past month, please describe… | How often your child is picked on by other children. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (being bullied) |
25 | PedPxySD08 | In the past month, please describe… | How often your child is teased and made fun of by other children. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (being bullied) |
26 | PedPxySD09 | In the past month, please describe… | How often your child is pushed or shoved around by other children. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Peer relationships (being bullied) |
Social Distress - Rejection by Siblings | |||||
27 | PedPxySD11m | In the past month, please describe… | How often your child is left out by his/her brothers or sisters. | 0= N/A - child does not have brothers or sisters 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Sibling relationships (rejection) |
28 | PedPxySD12m | In the past month, please describe… | How often your child's brothers or sisters refuse to let him/her play with them. | 0= N/A - child does not have brothers or sisters 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Sibling relationships (rejection) |
29 | PedPxySD13m | In the past month, please describe… | How often your child is not chosen as a playmate by his/her brothers or sisters. | 0= N/A - child does not have brothers or sisters 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Sibling relationships (rejection) |
30 | PedPxySD14m | In the past month, please describe… | How often your child is actively rejected by his/her brothers or sisters who refuse to play with him/her. | 0= N/A - child does not have brothers or sisters 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Sibling relationships (rejection) |
31 | PedPxySD15m | In the past month, please describe… | How often your child is avoided by his/her brothers or sisters. | 0= N/A - child does not have brothers or sisters 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Sibling relationships (rejection) |
32 | PedPxySD16m | In the past month, please describe… | How often your child is not well liked by his/her brothers or sisters. | 0= N/A - child does not have brothers or sisters 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Sibling relationships (rejection) |
33 | PedPxySD17m | In the past month, please describe… | How often your child is picked on by his/her brothers or sisters. | 0= N/A - child does not have brothers or sisters 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Sibling relationships (being bullied) |
34 | PedPxySD18m | In the past month, please describe… | How often your child is teased and made fun of by his/her brothers or sisters. | 0= N/A - child does not have brothers or sisters 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Sibling relationships (being bullied) |
35 | PedPxySD19m | In the past month, please describe… | How often your child is pushed or shoved around by his/her brothers or sisters. | 0= N/A - child does not have brothers or sisters 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health Behavior Questionnaire - Sibling relationships (being bullied) |
Positive Social Development - Empathic Behavior | |||||
For the next set of questions, please choose the answer that tells how often your child behaved that way in the past month. | |||||
36 | PedPxyPSD1 | In the past month, please describe… | How often your child tries to stop a fight or argument. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
37 | PedPxyPSD3 | In the past month, please describe… | How often your child invites other children to join in a game. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
38 | PedPxyPSD4 | In the past month, please describe… | How often your child tries to help someone who has been hurt. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
39 | PedPxyPSD6 | In the past month, please describe… | How often your child shares candies and extra food. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
40 | PedPxyPSD10 | In the past month, please describe… | How often your child takes the opportunity to praise the work of less able children. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
41 | PedPxyPSD11 | In the past month, please describe… | How often your child shows sympathy to someone who has made a mistake. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
42 | PedPxyPSD12 | In the past month, please describe… | How often your child offers to help other children who are having difficulty. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
43 | PedPxyPSD13 | In the past month, please describe… | How often your child helps other children who are feeling sick. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
44 | PedPxyPSD15 | In the past month, please describe… | How often your child comforts a child who is crying or upset. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
45 | PedPxyPSD18 | In the past month, please describe… | How often your child claps or smiles if someone else does something well. | 1 = Never 2 = Rarely 3 = Sometimes 4 = Usually 5 = Always |
HBQ - MacArthur Health and Behavior Questionnaire: Prosocial Behaviors Scale |
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