Name:
Email :
1.)
Does your child come home with unexplained injuries?
a)
Yes, often
b)
Occasionally
c)
No
2.) Does your child seem withdrawn?
a)
Yes, often
b)
Occasionally
c)
No
3.) At the thought of going to school does your child:
a)
Become upset/distressed/worried/scared/have trouble sleeping/feign illness?
b)
Complain/protest?
c)
Seem not bothered or like the thought of it?
4.) In terms of your child’s friendship group, do you recognise any of the following:
a)
They’ve stopped calling round, stopped ringing, not meeting up with them as usual, your child spends significantly more time on their own?
b)
They don't come round as often, he/she doesn’t talk about them, or he/she has new friends who they are secretive about?
c)
Has lots of friends or good supportive friendships, seems happy with their friends, talks about their friends often?
5.) Have you or anyone else noticed any changes in your child’s behaviour, including the following:
a)
They are more aggressive, they are often angry, become secretive, become defensive, less forthcoming?
b)
They are sulking more, they seem more unreasonable, or they don't want to talk to you?
c)
No significant change?
6.) Has your child recently (since the beginning of the school year or in the past year) come home from school crying?
a)
Yes, often.
b)
Yes once or twice.
c)
No, never.
7.) Has your child recently (since the beginning of the school year or in the past year) been in trouble at school for fighting?
a)
Yes, often.
b)
Yes once or twice.
c)
No, never.
8.) Has your child recently (since the beginning of the school year or in the past year) truanted from school?
a)
Yes all the time.
b)
Once or twice.
c)
Not as far as I'm aware.
9.) When your child is using their mobile phone do they ever:
a)
Seem upset or angry, receive calls late at night/early in the morning, refuse to discuss the calls/texts?
b)
Seems anxious when his/her phone goes off, is secretive about who is calling/texting?
c)
Spends all their time on the phone, mostly happy chatting and texting?
10.) Has your child
a)
Stopped going on the computer, become angry or upset when using the computer, become agitated or anxious whilst using the computer?
b)
Become secretive and doesn't like you looking over their shoulder at what they are doing on their computer, only uses their computer in their bedroom?
c)
Happily uses the computer in front of you in a family environment, enjoys using the computer and talks openly about their use of the computer?
Errors