31 Emotional Health Questionaire

NIH Toolbox for Assessment of Neurological and Behavioral Function (NIA)

Attach 31 Emotional Health Questionnaires for Toolbox.xlsx

Parent Proxies (baseline only + retest)

OMB: 0925-0638

Document [xlsx]
Download: xlsx | pdf

Overview

Cover Page
Overview
18+ NA (SELF)
8-17 NA (SELF)
8-12 NA (PROXY)
3-7 NA (PROXY)
18+ PA (SELF)
13-17 PA (SELF)
8-12 PA (SELF)
8-12 PA (PROXY)
3-7 PA (PROXY)
18+ S&SE (SELF)
13-17 S&SE (SELF)
8-12 S&SE (SELF)
8-12 S&SE (PROXY)
18+ SR (SELF)
8-17 SR (SELF)
3-12 SR (PROXY)


Sheet 1: Cover Page

Attachment 31


Emotional Health Questionnaires for Toolbox

Sheet 2: Overview

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.

Sheet 3: 18+ NA (SELF)

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

Sheet 4: 8-17 NA (SELF)

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

Sheet 5: 8-12 NA (PROXY)

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

Sheet 6: 3-7 NA (PROXY)

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

Sheet 7: 18+ PA (SELF)

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

Sheet 8: 13-17 PA (SELF)

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








Sheet 9: 8-12 PA (SELF)

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

Sheet 10: 8-12 PA (PROXY)

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













Sheet 11: 3-7 PA (PROXY)

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

Sheet 12: 18+ S&SE (SELF)

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

Sheet 13: 13-17 S&SE (SELF)

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

Sheet 14: 8-12 S&SE (SELF)

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





































Sheet 15: 8-12 S&SE (PROXY)

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

Sheet 16: 18+ SR (SELF)

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

Sheet 17: 8-17 SR (SELF)

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

Sheet 18: 3-12 SR (PROXY)

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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