Please answer these questions about your child. Keep in mind how your child usually behaves. If you have seen your child do the behavior a few times, but he or she does not usually do it, then please answer no. Please circle yes or no for every question. Thank you very much.
We thank you for your cooperation and time in helping us provide optimal care for your child.
© 2009 Diana Robins, Deborah Fein, & Marianne Barton
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