After completing this questionnaire, you'll be able to:
Email to your child - Click a button to open your email with pre-filled details
Download and send yourself - Download the results file and send it to your child
Note: Your child will then forward your results to their clinician.
Important Notice:
This questionnaire is for information gathering purposes only and is not diagnostic. The responses you provide will be reviewed by a clinician as part of a comprehensive clinical assessment. Only a qualified healthcare professional can make diagnostic or treatment decisions. Please answer honestly based on your actual memories.
Privacy: All data is processed locally on your device. Nothing is sent anywhere until you choose to download and share your results file with your clinician.
Instructions for Parent: You have been asked to complete this questionnaire about your child's behaviour when they were between 7 and 12 years of age.
📝 Answering Questions: You may leave questions blank if you're unsure or they don't apply. Don't guess - skipped items will be excluded from score calculations. However, try to answer as many as you can for accurate results.
0 of 26 items answered (26 skipped) (0%)
Information
Childhood Behaviour (Ages 7-12)
Rate your child's behaviour when they were between 7 and 12 years of age
0 = Never/rarely1 = Sometimes2 = Often3 = Very often (several times per hour/day)
Impact on Daily Life (Ages 7-12)
To what extent did these behaviours interfere with your child's functioning between ages 7-12?
0 = Never/rarely1 = Sometimes2 = Often3 = Very often (several times per hour/day)
✓ Questionnaire Complete
Thank you for completing this questionnaire
Your responses have been saved. Please send your results to your child using one of the options below.
Send Results to Your Child:
Option 1: Click "Email Results" to open your email app with instructions. Attach the file and send to your child. Option 2: Download the file and send it to your child yourself.
Your child will then forward your responses to their clinician (Dr. Shah at draanashah@protonmail.com).