image004
Not
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? _
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