| As a child I was or had: | not at all or very slightly | mildly | moderately | quite a bit | very much | |
|---|---|---|---|---|---|---|
| 1 | active restless always on the go | |||||
| 2 | afraid of things | |||||
| 3 | concentration problems, easily distracted | |||||
| 4 | anxious worrying | |||||
| 5 | nervous fidgety | |||||
| 6 | inattentive daydreaming | |||||
| 7 | hot- or short-tempered low boiling point | |||||
| 8 | shy sensitive | |||||
| 9 | temper outbursts tantrums | |||||
| 10 | trouble with stick-to-it-tiveness not following through. failing to finish things started | |||||
| 11 | stubborn strong-willed | |||||
| 12 | sad or blue depressed unhappy | |||||
| 13 | incautious. dare-devilish involved in pranks | |||||
| 14 | not getting a kick out of things dissatisfied with life | |||||
| 15 | disobedient with parents rebellious sassy | |||||
| 16 | low opinion of myself | |||||
| 17 | irritable | |||||
| 18 | outgoing friendly enjoyed company of people | |||||
| 19 | sloppy disorganized | |||||
| 20 | moody ups and downs | |||||
| 21 | angry | |||||
| 22 | friends popular | |||||
| 23 | well-organized tidy neat | |||||
| 24 | acting without thinking, impulsive | |||||
| 25 | tendency to be immature | |||||
| 26 | guilty feelings regretful | |||||
| 27 | losing control of myself | |||||
| 28 | tendency to be or act irrational | |||||
| 29 | unpopular with other children, didn't keep friends for long, didn't get along with other children | |||||
| 30 | poorly coordinated, did not participate in sports | |||||
| 31 | afraid of losing control of self | |||||
| 32 | well-coordinated picked first in games | |||||
| 33 | tomboyish (for women only) | |||||
| 34 | running away from home | |||||
| 35 | getting into fights | |||||
| 36 | teasing other children | |||||
| 37 | leader bossy | |||||
| 38 | difficulty getting awake | |||||
| 39 | follower led around too much | |||||
| 40 | trouble seeing things from someone else's point of view | |||||
| 41 | trouble with authorities, trouble with school visits to principal's office | |||||
| 42 | trouble with police, booked, convicted | |||||
| Medical problems as a child: | not at all or very slightly | mildly | moderately | quite a bit | very much | |
| 43 | headaches | |||||
| 44 | stomachaches | |||||
| 45 | constipation | |||||
| 46 | diarrhea | |||||
| 47 | food allergies | |||||
| 48 | other allergies | |||||
| 49 | bedwetting | |||||
| As a child in school I was (or had): | not at all or very slightly | mildly | moderately | quite a bit | very much | |
| 50 | overall a good student fast | |||||
| 51 | overall a poor student slow learner | |||||
| 52 | slow in learning to read | |||||
| 53 | slow reader | |||||
| 54 | trouble reversing letters | |||||
| 55 | problems with spelling | |||||
| 56 | trouble with mathematics or numbers | |||||
| 57 | bad handwriting | |||||
| 58 | able to read pretty well but never really enjoyed reading | |||||
| 59 | not achieving up to potential | |||||
| 60 | repeating grades | |||||
| 61 | suspended or expelled | |||||