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Slgnlflcant

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Parental dlstress    slgnlflcant

How distressed are you?    _

Are you experiencing financial pressures or increased

responsibilities?    _

Have you experienced morę conflict

with key people in your life?    _

Separatlon

How much separacion has your

child experienced lately?    _

Has your business travel increased?

Has a sibling gone off to school?

Has a best friend moved away?

Has che lengch of time in child care

or with sitters increased?    _

Upsettlng events

Has your child been exposed to

potentially upsetting events?    _

Has there been a major storm, or

natural disaster?    _

Did someone in your family

experience illness?    _

Major changes

How many significant changes has your child experienced in the last

six months?    _

Has there been a divorce or a move?

Has your family recently traveled?

Loslngsleep

Was your child unable to nap?    _

Did bedtime end up later because

of other commitments?    _