Start
wchads_08_ph08mi
Wirral Child Health and Development Study
Part 1
Hello again! We are very grateful to you for helping us with this important research. Your baby will be over 12 months old now. We want to ask you about what your baby is like, about their health over the past year, your health, family changes and your feelings recently. We are asking all the mothers in our study to do this to help us understand more about life after a first baby and how babies differ from each other as they develop. The questions we ask are not a test, so there are no right or wrong answers. Please just say how things really are for you now. When you have finished please put the form in the stamped addressed envelope provided and return it in the post to us. IF YOU HAVE QUESTIONS ABOUT THIS OR YOU NEED ANY HELP TO COMPLETE THE QUESTIONNAIRE PHONE US FREE ON 0800 0517597 AND WE WILL BE PLEASED TO HELP YOU.

What is the date today?

Generic date
First, some questions about your baby...
(If you had twins please complete this part about the first born baby – and complete the separate booklet we have posted to you about your second born baby)

What is your baby's age now? … months and … weeks old

Age in months
Weeks

What does your child look like? His/her hair is:

(Please circle a response)

1
black
2
dark brown
3
light brown
4
fair
5
reddish
6
other
Other

What does your child look like? His/her eyes are:

(Please circle a response)

1
blue
2
brown
3
green
4
other
Other

What does your child look like? Does she or he remind you of anyone strongly ?

(please tick a box)

1
Yes, her/his father
2
Yes, myself
3
Yes, another family member
4
No, not strongly of one person
5
Other (please explain)
Other

How would you describe your BABY'S ETHNIC ORIGIN?

(please tick a box)

1
Bangladeshi
2
Black African
3
Black Caribbean
4
Chinese
5
Greek/Greek Cypriot
6
Indian
7
Irish
8
Other Black
9
Pakistani
10
Turkish/Turkish Cypriot
11
White
12
Other
If you feel that the categories above do not accurately reflect your baby’s ethnic origin,
qc_s1_3 == 12

please describe their ethnic origin below:

Other

Has YOUR BABY had any physical health problems since birth which needed medical attention?

a
No
b
Yes, but did not seek help
c
Yes, treated by GP
d
Yes, treated as hospital outpatient
e
Yes, required hospital admission

Please give details of his/her physical health problems below:

Generic text

Do you have concerns about your baby's health now?

(please circle a response below)

1
No concerns
2
Minor concerns
3
Major concerns

Please give details of any concerns you have

Generic text
However careful a parent is, most children have accidents at some time or other. Please tell us on the set of questions below about the times your child has had an accident, at what age and if there was any treatment given.
How many times? (please tick a box) How old was he/she in months? What did the person with your child do about the accident? (please tick a box)

1 - Once

2 - Twice

3 - 3 or more

4 - Never

Age in months

1 - Nothing

2 - Treated child themselves

3 - Took child to GP

4 - Took child to hospital

5 - Other

1 - Once

2 - Twice

3 - 3 or more

4 - Never

Age in months

1 - Nothing

2 - Treated child themselves

3 - Took child to GP

4 - Took child to hospital

5 - Other

1 - Once

2 - Twice

3 - 3 or more

4 - Never

Age in months

1 - Nothing

2 - Treated child themselves

3 - Took child to GP

4 - Took child to hospital

5 - Other

Been burnt or scalded
Been dropped or had a bad fall
Swallowed anything she or he shouldn't (e.g., pills, buttons, disinfectant)
Had any other accidents or injuries ?

However careful a parent is, most children have accidents at some time or other. Please tell us on the set of questions below about the times your child has had an accident, at what age and if there was any treatment given. Has your child ever … Been burnt or scalded What did the person with your child do about the accident? (please tick a box) Other...

Other

However careful a parent is, most children have accidents at some time or other. Please tell us on the set of questions below about the times your child has had an accident, at what age and if there was any treatment given. Has your child ever … Been dropped or had a bad fall What did the person with your child do about the accident? (please tick a box) Other...

Other

However careful a parent is, most children have accidents at some time or other. Please tell us on the set of questions below about the times your child has had an accident, at what age and if there was any treatment given. Has your child ever … Swallowed anything he or she shouldn't (e.g., pills, buttons, disinfectant) What did the person with your child do about the accident? (please tick a box) Other..

Other

However careful a parent is, most children have accidents at some time or other. Please tell us on the set of questions below about the times your child has had an accident, at what age and if there was any treatment given. Has your child ever … Had any other accidents or injuries ? What did the person with your child do about the accident? (please tick a box) Other...

Other

Has or does your child's chest ever wheeze or whistle?

1
YES
2
NO

Does your child's chest ever wheeze or whistle when he/she does have a cold?

1
YES
2
NO

Does your child's chest ever wheeze or whistle when he/she doesn't have a cold?

1
YES most nights
2
Yes occasionally
3
No

At what age did the wheezing or whistling start? ... months of age

Age in months

Please tell us how often during the day your child is in a room or enclosed place where people are smoking? How often... On weekdays?

Please circle a response

1
Not at all
2
Less than 1 hour
3
1 or 2 hours
4
3, 4, or 5 hours
5
More than 5 hours
6
All the time

Please tell us how often during the day your child is in a room or enclosed place where people are smoking? How often... At weekends?

Please circle a response

1
Not at all
2
Less than 1 hour
3
1 or 2 hours
4
3, 4, or 5 hours
5
More than 5 hours
6
All the time

Many families have pet animals at home, which pets is your child in contact with at least once a week either in your home or elsewhere? cat(s)

(please circle YES or NO for each pet)

1
YES
2
NO

Many families have pet animals at home, which pets is your child in contact with at least once a week either in your home or elsewhere? dog(s)

(please circle YES or NO for each pet)

1
YES
2
NO

Many families have pet animals at home, which pets is your child in contact with at least once a week either in your home or elsewhere? other furry pet*(s)

(please circle YES or NO for each pet)

1
YES
2
NO

Many families have pet animals at home, which pets is your child in contact with at least once a week either in your home or elsewhere? other pet*(s)

(please circle YES or NO for each pet)

1
YES
2
NO
If Yes to question qc_s1_12_c or Yes to question qc_s1_12_d
qc_s1_12_c == 1 || qc_s1_12_d == 1

*please describe which animals she / he has contact with

Other

How well does your child sleep at night? Please place a tick next to each statement that correctly describes your child ...

(you can tick as many as you wish)

1
He/she sleeps through the night
2
He/she sleeps only a small amount each night
3
He/she has difficulty settling to sleep by him/herself (without being rocked, fed or sucking a dummy etc)
4
He/she often wakes up for the day, very early in the morning
5
He/she often wakes more than once, crying during the night
6
He/she is restless (moves about a lot) during sleep
7
He/she does not settle to sleep during the day for a nap
If He/she sleeps only a small amount each night to question qc_s1_13_i
qc_s1_13_i == 2

How many hours is typical? ... hrs

How many

How often do you find yourself doing each of the following things with your baby now? I stroke my baby's tummy.

Please tick a box to say how often you find yourself doing each thing …

1
Never
2
Rarely
3
Sometimes
4
Often
5
A lot

How often do you find yourself doing each of the following things with your baby now? I stroke my baby's back.

Please tick a box to say how often you find yourself doing each thing …

1
Never
2
Rarely
3
Sometimes
4
Often
5
A lot

How often do you find yourself doing each of the following things with your baby now? I stroke my baby's arms or legs

Please tick a box to say how often you find yourself doing each thing …

1
Never
2
Rarely
3
Sometimes
4
Often
5
A lot

How often do you find yourself doing each of the following things with your baby now? I talk to my baby

Please tick a box to say how often you find yourself doing each thing …

1
Never
2
Rarely
3
Sometimes
4
Often
5
A lot

How often do you find yourself doing each of the following things with your baby now? I cuddle my baby

Please tick a box to say how often you find yourself doing each thing …

1
Never
2
Rarely
3
Sometimes
4
Often
5
A lot

How often do you find yourself doing each of the following things with your baby now? I hold my baby

Please tick a box to say how often you find yourself doing each thing …

1
Never
2
Rarely
3
Sometimes
4
Often
5
A lot

How often do you find yourself doing each of the following things with your baby now? I leave her/him to play alone

Please tick a box to say how often you find yourself doing each thing …

1
Never
2
Rarely
3
Sometimes
4
Often
5
A lot

How often do you find yourself doing each of the following things with your baby now? I read to my baby

Please tick a box to say how often you find yourself doing each thing …

1
Never
2
Rarely
3
Sometimes
4
Often
5
A lot

How often do you find yourself doing each of the following things with your baby now? I play with my baby

Please tick a box to say how often you find yourself doing each thing …

1
Never
2
Rarely
3
Sometimes
4
Often
5
A lot

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies should be picked up whenever they cry

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... It is important to develop a regular pattern of feeding and sleeping with a baby

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies should be fed whenever they are hungry

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies need to be stimulated if they are to develop well

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies need quiet secure surroundings and should not be disturbed too much

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Parents need to adapt their lives to the baby's demands

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... A baby should fit into the parent's routine

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies should be left to develop naturally

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Talking, to even a very young baby, is important

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree

Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Cuddling a baby is very important

Please tick a box to show how much you agree with each of these statements..

1
Yes, I agree
2
I'm unsure but probably agree
3
I'm unsure but probably disagree
4
No, I disagree
Who helps with childcare?
Most children are looked after by more than one person at some time. Apart from yourself, who regularly looks after your baby when you are out of the house or at work?

(Please answer for each person regularly involved. If no one else helps care for him/her, tick the 'no' column all the way down)

No Yes If YES, Please give hours per week If YES, Please give age of baby when this began (in months)

1 - tick

1 - tick

Hours in weekAge in months

1 - tick

1 - tick

Hours in weekAge in months

1 - tick

1 - tick

Hours in weekAge in months

1 - tick

1 - tick

Hours in weekAge in months
my baby’s father
my current partner
baby's grandparent
other relative
friend/neighbour
paid person outside baby's home (eg. child minder)
paid person in baby's home (eg. nanny, baby sitter)
day nursery (or creche)
other (please describe)

Most children are looked after by more than one person at some time. Apart from yourself, who regularly looks after your baby when you are out of the house or at work? other (please describe)

Other

How satisfied are you with these childcare arrangements?

1
Very satisfied
2
Fairly satisfied
3
Not at all satisfied

Any comments about your childcare arrangements:

Generic text

In a typical week, how much time does your child spend with other young children (not including brothers and sisters)? … hours per week

Hours in week

Over the past year which health and/or support services have been involved with you and your child? Health visitor

(please circle yes or no for each type of service)

1
Yes
2
No

Over the past year which health and/or support services have been involved with you and your child? GP

(please circle yes or no for each type of service)

1
Yes
2
No

Over the past year which health and/or support services have been involved with you and your child? Social worker

(please circle yes or no for each type of service)

1
Yes
2
No

Over the past year which health and/or support services have been involved with you and your child? CPN

(please circle yes or no for each type of service)

1
Yes
2
No

Over the past year which health and/or support services have been involved with you and your child? Paediatrician

(please circle yes or no for each type of service)

1
Yes
2
No

Over the past year which health and/or support services have been involved with you and your child? Children's centre

(please circle yes or no for each type of service)

1
Yes
2
No

Over the past year which health and/or support services have been involved with you and your child? Surestart worker

(please circle yes or no for each type of service)

1
Yes
2
No

Over the past year which health and/or support services have been involved with you and your child? CHiCC team

(please circle yes or no for each type of service)

1
Yes
2
No

Over the past year which health and/or support services have been involved with you and your child? Family Support Worker

(please circle yes or no for each type of service)

1
Yes
2
No

Over the past year which health and/or support services have been involved with you and your child? Other (please say who …)

Other
Next, we just need to catch up on changes in your living arrangements since we last asked...

Who lives with you in your household now?

(Please list relationship to you and age of each one) e.g. Husband 36; Partner 27; Mother 58; step-son 3; etc.

Generic text
Generic text 2
Generic text 3
Generic text 4
Generic text 5
Generic text 6

What type of housing do you live in now?

(Please circle one answer from the list below)

1
House
2
Flat
3
Bedsit
4
Maisonette
5
Work-related accommodation
6
caravan
7
hostel
8
Student residence
9
Or Other (please describe)
Other

What is your correct postcode?

Postcode

Is the place where you live owned or rented by you?

(Please circle one answer from the list below)

1
Owner occupied
2
rented from private landlord
3
rented from council or housing association
4
Accomodation provided by work - pay rent
5
Accomodation provided by work - no rent
6
guest in someone else's home
7
other (please describe)
Other

How many bedrooms do you have?

How many

How many rooms in total are there?

How many

How long have you lived there? … years … months

Years Months

How satisfied are you with your housing?

(please tick a box)

1
Very satisfied
2
Satisfied
3
Dissatisfied
4
Very dissatisfied

What do you think of your neighbourhood as a place to live?

(please tick a box)

1
a very good place to live
2
a fairly good place to live
3
not a very good place to live
4
not at all a good place to live
Next we need to catch up on your work / home situation now...

What is your employment status now?

(please tick one or more box to tell us)

1
Full-time paid employment
2
Part time paid employment
3
Self-employed
4
Full-time education/training
5
Voluntary work
6
Other (please give details) More Details
7
On sick leave or disability
8
On maternity leave from work
9
Unemployed, looking for work
10
Part-time education or training
11
Full-time education and part-time work
12
Full time mother at home
Other
If you are working,
qc_s4_1_i == 1 || qc_s4_1_i == 2 || qc_s4_1_i == 3 || qc_s4_1_i == 5 || qc_s4_1_i == 11

approximately how many hours do you work each week? … hours

Hours in week

If you do work, what are the main reasons you work?

(please tick one or more box to tell us)

1
Financial, I am important as a breadwinner
2
Financial, for family extras
3
Career
4
Enjoyment
5
To give me time for myself
6
Other (please describe)
Other
Your relationship status now...

Are you currently:

(Please tick a box)

1
Single
2
Cohabiting (Living with a partner)
3
With partner who lives elsewhere
4
Other (please describe below)
5
Married
6
Separated
7
Widowed
8
Divorced
Other

Is this the same as when we spoke to you at your 20 week scan appointment?

(please tick a box)

1
Yes the same - I am single like before
2
Yes the same - I am living with the same partner
3
Yes the same - my partner still lives elsewhere
4
No things are different - I am now living with my partner
5
No things are different - I am now in a new relationship but we are not living together
6
No things are different - I am now living with a new partner
7
No - My previous relationship ended and I am now single
8
Other – can you give brief details below
Other
(please jump to the next question if you were single at the 20 week scan)
QC_s5_2 == 1
Else

Thinking of the partner you were with when you were pregnant at your 20 weeks scan ... How long had you been together when you ...became pregnant ? ... years ... month (s) OR

(tick if this is true)

Years Months
1
We were not together then

Thinking of the partner you were with when you were pregnant at your 20 weeks scan ... How long had you been together when you ...started to live together ? ... years ... month (s) OR

(tick if this is true)

Years Months
1
We do not / did not live together

Thinking of the partner you were with when you were pregnant at your 20 weeks scan ... How long had you been together when you ...got engaged? ... years ... month (s) OR

(tick if this is true)

Years Months
1
We did not get engaged

Thinking of the partner you were with when you were pregnant at your 20 weeks scan ... How long had you been together when you ...got married? ... years ... month (s) OR

(tick if this is true)

Years Months
1
We did not get married

Have you had a new partner since your 20 week scan in pregnancy?

(please circle)

1
YES
2
NO
If YES, please answer (a) to (d) below...
qc_s5_4 == 1

How long have you and your current partner been together now ?

Years Months

How long had you and your current partner been together when you ..started to live together? ... years ... month (s) OR

(tick if this is true)

Years Months
1
we do not / did not live together

How long had you and you current partner been together when you …got engaged ? ... years ... month (s) OR

(tick if this is true)

Years Months
1
We have not / did not get engaged

How long had you and your current partner been together when you…got married ? ... years ... month (s) OR

(tick if this is true)

Years Months
1
we have not / did not get married
Some brief information about your current partner NOW...
(If you do not have a partner now please jump to the next section about family income)
qc_s5_1 == 1 || qc_s5_1 == 6 || qc_s5_1 == 7 || qc_s5_1 == 8
Else

How old is your partner now? … (years)

Age

How old were they when they finished full-time education? … years

Age

What is their employment status now?

(please tick a box to tell us)

1
Full-time paid employment
2
Part time paid employment
3
Self-employed
4
Unemployed
5
Other (please give details) More details
6
On sick leave or disability
7
Fulltime education or training scheme
8
Part-time education or training scheme
9
Voluntary work
10
Full-time parent at home
Other

If your partner is working, how many hours do they work each week? … hours

Hours in week
Your household income
Many families experience changes in their finances after they start having children. Please tell us about your situation now...

What is your approximate annual FAMILY income now?

(Please tick a box below)

1
Up to £10,000
2
£10,000-£20,000
3
£21,000 - £30,000
4
£31,000-£40,000
5
£41,000 - £50,000
6
£51,000 - £60,000
7
£61,000-£70,000
8
over £71,000
9
Don't Know

Are you receiving any benefits now?

(Please tick ALL relevant boxes below)

1
Income Support
2
Tax Credits
3
Carers Allowance
4
Child Benefit
5
Incapacity Benefit
6
New Deal
7
Council Tax Benefit
8
Other (please give details below) More details
9
Job Seekers Allowance
10
Disability Living Allowance
11
Housing Benefit
Other

Do you have financial problems at the moment?

(please circle a response)

1
Not at all
2
A few
3
A lot

At the moment, how difficult do you find it to afford any or all of these items? Food

Please put a tick in one box for each item…

1
Very difficult
2
Fairly difficult
3
Slightly difficult
4
Not difficult

At the moment, how difficult do you find it to afford any or all of these items? Clothing

Please put a tick in one box for each item…

1
Very difficult
2
Fairly difficult
3
Slightly difficult
4
Not difficult

At the moment, how difficult do you find it to afford any or all of these items? Heating

Please put a tick in one box for each item…

1
Very difficult
2
Fairly difficult
3
Slightly difficult
4
Not difficult

At the moment, how difficult do you find it to afford any or all of these items? Rent or mortgage

Please put a tick in one box for each item…

1
Very difficult
2
Fairly difficult
3
Slightly difficult
4
Not difficult

At the moment, how difficult do you find it to afford any or all of these items? Things you need for the baby

Please put a tick in one box for each item…

1
Very difficult
2
Fairly difficult
3
Slightly difficult
4
Not difficult
Now, some questions about your own health...

Have YOU had any physical health problems since your baby was born which required medical attention?

(Please tick a box)

1
No
2
Yes, but I have not had treatment
3
Yes, treated by GP
4
Yes, treated as hospital outpatient
5
Yes, required hospital admission

Please give details

Generic text

Have YOU had any emotional problems since your baby was born which required help?

(Please tick a box)

1
No
2
Yes, but I have not had treatment
3
Yes, treated by GP
4
Yes, treated as hospital outpatient
5
Yes, required hospital admission

Please give details

Generic text

Since your baby's birth have you taken medicines prescribed by the doctor?

(please circle a response)

1
Yes
2
No

Please give name(s) of these medicines:

Generic text

Since your baby was born have you taken any of the following sorts of medicines? Sleeping pills

Please tick a box to say how often..

1
Yes, in the first 6 months
2
Yes, between 6 and 12 months after birth
3
No, not since my baby was born

Since your baby was born have you taken any of the following sorts of medicines? Pills to calm anxiety or 'nerves'

Please tick a box to say how often..

1
Yes, in the first 6 months
2
Yes, between 6 and 12 months after birth
3
No, not since my baby was born

Since your baby was born have you taken any of the following sorts of medicines? Pills to treat depression

Please tick a box to say how often..

1
Yes, in the first 6 months
2
Yes, between 6 and 12 months after birth
3
No, not since my baby was born

Do you feel that you are getting enough sleep?

(please circle)

1
Yes
2
No

During an average night how many hours sleep do you get?

(please tick)

1
None
2
1-3 hrs
3
4-5 hrs
4
6-7 hrs
5
Over 7 hours a night

Since your first baby was born have you become pregnant again?

1
Yes
2
No
(If No, please jump to questions on lifestyle)
qc_s8_7_a == 2
Else

If yes, what was the date of the last menstrual period before this new pregnancy?

(if you do not remember it put 99 99 99):

Generic date

If yes, what happened to this pregnancy?

1
I am still pregnant
2
I had a miscarriage
3
I had a termination of pregnancy
4
I have given birth to the baby
(please give date of birth and sex of baby below)
qc_s8_7_c == 4

Date of birth:

Date of birth

What sex is your new baby?

(please circle)

1
male
2
female
Your lifestyle now

How many cigarettes do you smoke each day, on average?

1
None
2
Less than 10
3
Between 10 and 20
4
More than 20

Over the past year, have you drunk alcohol?

(Please circle)

1
YES
2
NO
If YES,
qc_s9_2_a == 1

how many drinks do you have PER WEEK? ... per week

(Please tick a box below)

1
Less than one drink
2
One to six drinks
3
Six to twelve
4
More than twelve

how often do you have 6 drinks or more on one occasion?

(Please tick a box below)

1
Never
2
Less than monthly
3
Monthly
4
Weekly
5
Daily or almost daily

Which of the recreational drugs below have you taken in the past year? Cannabis/marihuana

Please say how often?

1
Every day
2
Often
3
Sometimes
4
Not at all

Which of the recreational drugs below have you taken in the past year? Amphetamines or other stimulants

Please say how often?

1
Every day
2
Often
3
Sometimes
4
Not at all

Which of the recreational drugs below have you taken in the past year? Heroin, methadone, crack, cocaine

Please say how often?

1
Every day
2
Often
3
Sometimes
4
Not at all
Your relationship recently...
Relationships can be a source of support and a source of stress at different times for all of us. We need to learn more about how relationships change in the year following childbirth so we can develop ways of better supporting families in future. We’d like to ask you three brief questions about how satisfied you are with your relationship now.
Like all the information you give us, your responses will be kept private and confidential.

Please circle the response that best fits how you feel now? How satisfied are you with your marriage / relationship?

1
Extremely Dissatisfied
2
Very Dissatisfied
3
Somewhat Dissatisfied
4
Mixed
5
Somewhat Satisfied
6
Very Satisfied
7
Extremely Satisfied

Please circle the response that best fits how you feel now? How satisfied are you with your husband / partner?

1
Extremely Dissatisfied
2
Very Dissatisfied
3
Somewhat Dissatisfied
4
Mixed
5
Somewhat Satisfied
6
Very Satisfied
7
Extremely Satisfied
If you don’t have a current partner or boyfriend at the moment but your baby’s father is in contact with your child then complete question 3 only or If Cohabiting (Living with a partner) or With a partner who lives elsewhere or Married to question qc_s5_1
(qc_5_1 == 1 || qc_5_1 == 6 || qc_5_1 == 8) || (qc_5_1 == 2 || qc_5_1 == 3 || qc_5_1 == 5)

Please circle the response that best fits how you feel now? How satisfied are you with your husband / partner's contribution to parenting so far?

1
Extremely Dissatisfied
2
Very Dissatisfied
3
Somewhat Dissatisfied
4
Mixed
5
Somewhat Satisfied
6
Very Satisfied
7
Extremely Satisfied

Becoming a parent can be enjoyable and challenging! The following questions ask about the level of help and support you feel you have… I have no one to share my feelings with

Please tick us a box for each statement

1
This is exactly how I feel
2
This is often how I feel
3
This is sometimes how I feel
4
I never feel this way

Becoming a parent can be enjoyable and challenging! The following questions ask about the level of help and support you feel you have… My partner provides the emotional support I need

Please tick us a box for each statement

1
This is exactly how I feel
2
This is often how I feel
3
This is sometimes how I feel
4
I never feel this way

Becoming a parent can be enjoyable and challenging! The following questions ask about the level of help and support you feel you have… There are other mothers with whom I can share my experiences

Please tick us a box for each statement

1
This is exactly how I feel
2
This is often how I feel
3
This is sometimes how I feel
4
I never feel this way

Becoming a parent can be enjoyable and challenging! The following questions ask about the level of help and support you feel you have… There are members of my family who give me emotional support

Please tick us a box for each statement

1
This is exactly how I feel
2
This is often how I feel
3
This is sometimes how I feel
4
I never feel this way

The following questions are about your partner and the baby. He really enjoys this baby

Please tick a box to say if each statement is always, sometimes or never true?

1
Always
2
Sometimes
3
Never

The following questions are about your partner and the baby. He would really have preferred that we had not had this baby when we did

Please tick a box to say if each statement is always, sometimes or never true?

1
Always
2
Sometimes
3
Never

The following questions are about your partner and the baby. He likes to play with the baby

Please tick a box to say if each statement is always, sometimes or never true?

1
Always
2
Sometimes
3
Never

The following questions are about your partner and the baby. He is confident with the baby

Please tick a box to say if each statement is always, sometimes or never true?

1
Always
2
Sometimes
3
Never

The following questions are about your partner and the baby. He takes great pleasure in watching the baby develop

Please tick a box to say if each statement is always, sometimes or never true?

1
Always
2
Sometimes
3
Never

The following questions are about your partner and the baby. He really cannot bear it when the baby cries

Please tick a box to say if each statement is always, sometimes or never true?

1
Always
2
Sometimes
3
Never

The following questions are about your partner and the baby. He dislikes the mess that surrounds the baby

Please tick a box to say if each statement is always, sometimes or never true?

1
Always
2
Sometimes
3
Never

The following questions are about your partner and the baby. I trust him alone with the baby

Please tick a box to say if each statement is always, sometimes or never true?

1
Always
2
Sometimes
3
Never

The following questions are about your partner and the baby. He takes an active part in bringing up the baby

Please tick a box to say if each statement is always, sometimes or never true?

1
Always
2
Sometimes
3
Never
Postnatal stress

We would like to know how stressed or worried you have felt during the last 3 months. On the following scale 0 indicates feeling extremely relaxed and 10 indicates feeling extremely stressed or worried. Please circle a number to say how worried and stressed you have been feeling since your baby's birth?

0
0: No stress
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10: As stressed as you can possibly imagine
Your mood and feelings now?
A number of statements which people have used to describe themselves are given below. Read each statement and then circle the most appropriate number to the right of the statement to INDICATE HOW YOU FEEL RIGHT NOW, AT THIS MOMENT. There are no right or wrong answers. Do not spend too much time on any one statement but give the answer which seems to describe your present feelings best.

HOW DO YOU FEEL RIGHT NOW..? I feel calm

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel secure

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel tense

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I am strained

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel at ease

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I am upset

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I am presently worrying over possible misfortunes

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel satisfied

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel frightened

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel comfortable

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel self-confident

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel nervous

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel jittery

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel indecisive

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I am relaxed

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel content

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I am worried

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel confused

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel steady

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so

HOW DO YOU FEEL RIGHT NOW..? I feel pleasant

1
Not at all
2
Somewhat
3
Moderately so
4
Very much so
Your general health?

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been able to concentrate on whatever you are doing?

1
Better than usual
2
Same as usual
3
Less than usual
4
Much less than usual

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Lost much sleep over worry?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Felt that you are playing a useful part in things?

1
More so than usual
2
Same as usual
3
Less useful than usual
4
Much less useful

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Felt capable of making decisions about things?

1
More so than usual
2
Same as usual
3
Less so than usual
4
Much less capable

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Felt constantly under strain?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Felt you couldn't over come your difficulties?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been able to enjoy your normal day-to-day activities?

1
More so than usual
2
Same as usual
3
Less so than usual
4
Much less than usual

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been able to face up to your problems?

1
More so than usual
2
Same as usual
3
Less able than usual
4
Much less able

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been feeling unhappy and depressed?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been losing confidence in yourself?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been thinking of your self as a worthless person?

1
Not at all
2
No more than usual
3
Rather more than usual
4
Much more than usual

The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been feeling reasonably happy, all things considered?

1
More so than usual
2
About same as usual
3
Less so than usual
4
Much less than usual
How have you been feeling in the past week ...?
As you have recently had a baby, we would like to know how you are feeling now.
Please underline the answer which comes closest to how you have felt IN THE PAST WEEK, not just how you feel today.

In the past seven days I have been able to laugh and see the funny side of things:

1
As much as I always could
2
Not quite so much now
3
Definitely not so much now
4
Not at all

In the past seven days I have looked forward with enjoyment to things:

1
As much as I ever did
2
Rather less than I used to
3
Definitely less than I used to
4
Hardly at all

In the past seven days I have blamed myself unnecessarily when things went wrong:

1
Yes, most of the time
2
Yes, some of the time
3
Not very often
4
No, never

In the past seven days I have been anxious or worried for no good reason:

1
No, not at all
2
Hardly ever
3
Yes, sometimes
4
Yes, very often

In the past seven days I have felt scared or panicky for no very good reason:

1
Yes, quite a lot
2
Yes, sometimes
3
No, not much
4
No, not at all

In the past seven days Things have been getting on top of me:

1
Yes, most of the time I haven't been able to cope at all
2
Yes, sometimes I haven't been coping as well as usual
3
No, most of the time I have coped quite well
4
No, I have been coping as well as ever

In the past seven days I have been so unhappy that I have had difficulty sleeping:

1
Yes, most of the time
2
Yes, sometimes
3
Not very often
4
No, not at all

In the past seven days I have felt sad or miserable:

1
Yes, most of the time
2
Yes, quite often
3
Not very often
4
No, not at all

In the past seven days I have been so unhappy that I have been crying

1
Yes, most of the time
2
Yes, quite often
3
Only occasionally
4
No, never

In the past seven days The thought of harming myself has occurred to me:

1
Yes, quite often
2
Sometimes
3
Hardly ever
4
Never
Thank you for your help in completing this questionnaire and for all your time.
The answers to all these questions will help us understand the relationship between different levels of stress in pregnancy, family life and later child development so we can help other families in future.
Part 2
Phase 8: PART 2 Wirral Child Health and Development Study
Now we'd like to learn about your BABY's likes and dislikes.
All babies are different so we would like to learn from you a little more about your experience of your own baby so far ...
INSTRUCTIONS
As you read about each baby behaviour below, please tell us how often YOUR BABY did this during the LAST WEEK (the past seven days) by circling one of the numbers in the right hand column.
The “Does Not Apply” (X) column is used when you did not see the baby in the situation described during the last week. For example, if the situation mentions the baby having to wait for food or liquids and there was no time during the last week when the baby had to wait, circle the (X) column. “Does Not Apply” is different from “Never” (1).
“Never” (1) is used when you saw the baby in the situation but the baby never engaged in the behavior listed during the last week. For example, if the baby did have to wait for food or liquids at least once but never cried loudly while waiting, circle the (1) column.
SLEEPING

DURING THE PAST WEEK ... Before falling asleep at night, how often did your baby ...show no fussing or crying?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK ... How often did your baby ...seem angry (crying or fussing) when left you her/him in the cot?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK ... How often did your baby ...seem contented when left in the cot?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK ... How often did your baby ...cry or fuss before going to sleep for naps?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK ... During sleep how often did your baby ...toss about in the cot?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK ... During sleep how often did your baby ...move from the middle to the end of the crib

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK ... During sleep how often did your baby ...sleep in one position only

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK ... After sleeping, how often did your baby ... fuss or cry immediately?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK ... After sleeping, how often did your baby ... play quietly in the cot

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK ... After sleeping, how often did your baby ... cry if someone doesn't come within a few minutes?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply
FEEDING

DURING THE PAST WEEK? During feeding how often did the baby ...lie or sit quietly?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? During feeding how often did the baby ...squirm or kick?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? During feeding how often did the baby ...wave arms?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply
BATHING AND DRESSING

When his/her face was washed, how often did the baby: ...fuss or cry?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When his/her face was washed, how often did the baby: ...smile or laugh?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When his/her hair was washed, how often did the baby: ...fuss or cry?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When his/her hair was washed, how often did the baby: ...smile?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When being dressed or undressed during the last week, how often did the baby ...wave his/her arms and kick?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When being dressed or undressed during the last week, how often did the baby ...squirm and/or try to roll away?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When being dressed or undressed during the last week, how often did the baby ...smile or laugh?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When put into the bath water, how often did the baby ...splash or kick?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When put into the bath water, how often did the baby ...turn body and/or squirm?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When put into the bath water, how often did the baby …smile?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When put into the bath water, how often did the baby ...laugh?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply
PLAY

DURING THE PAST WEEK? When something the baby was playing with had to be removed, how often did s/he ...cry or show distress for a time?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When something the baby was playing with had to be removed, how often did s/he ...seem not bothered?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? How often during the last week did the baby: ...laugh aloud in play?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? How often during the last week did the baby: …smile or laugh after accomplishing something (e.g. stacking blocks)

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? How often during the last week did the baby: ...smile or laugh when given a toy?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When your baby saw a toy s/he wanted, how often did s/he: ...get very excited about getting it?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When your baby saw a toy s/he wanted, how often did s/he: ...immediately go after it?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When given a new toy, how often did your baby: ...get very excited about getting it?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When given a new toy, how often did your baby: ...immediately go after it?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When given a new toy, how often did your baby: ...seem not to get very excited about it?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply
DAILY ACTIVITIES

DURING THE PAST WEEK? How often during the last week did your baby ...cry or show distress at change in parents' appearance (glasses off, shower cap on, etc.)?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? How often during the last week did your baby ...protest being placed in a confining place (infant seat, play pen, car seat, etc)?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? How often during the last week did your baby ...startle at a sudden change in body position (e.g. when moved suddenly)?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? How often during the last week did your baby ...startle to a loud or sudden noise?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? How often during the last week did your baby ...move quickly toward new objects?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? How often during the last week did your baby ...show a strong desire for something s/he wanted?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? How often during the last week did your baby ...seem excited when you or other adults acted in an excited manner around him/her?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When placed on his/her back, how often did the baby ...fuss or protest?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When placed on his/her back, how often did the baby ...wave arms and kick?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When placed on his/her back, how often did the baby ...squirm and / or turn their body?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When placed on his/her back, how often did the baby ...smile or laugh?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When the baby wanted something, how often did s/he ...become upset when s/he could not get what s/he wanted?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When the baby wanted something, how often did s/he ...have tantrums (crying, screaming, face red, etc.) when s/he did not

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When the baby wanted something, how often did s/he ...get what s/he wanted?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When placed in an infant seat or car seat, how often did the baby ...show distress at first; then quiet down?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When placed in an infant seat or car seat, how often did the baby ...wave arms and kick?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When placed in an infant seat or car seat, how often did the baby ...squirm and turn body?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When placed in an infant seat or car seat, how often did the baby ...lie or sit quietly?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When something the baby was playing with had to be removed, how often did he/she ...cry or show distress for a time?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST WEEK? When introduced to a dog or cat, how often did the baby ...cry or show distress?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When introduced to an unfamiliar adult, how often did the baby: ...cling to a parent?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When introduced to an unfamiliar adult, how often did the baby: ...refuse to go to the unfamiliar person?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When introduced to an unfamiliar adult, how often did the baby: ...hang back from the adult?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When introduced to an unfamiliar adult, how often did the baby: ...never "warm up" to the unfamiliar adult?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When in the presence of several unfamiliar adults, how often s/he: ...cling to a parent?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When in the presence of several unfamiliar adults, how often s/he: ...cry?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When in the presence of several unfamiliar adults, how often s/he: ...continue to be upset for 10 minutes or longer?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When visiting a new place, how often did the baby ...show distress for the first few minutes?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When visiting a new place, how often did the baby ...continue to be upset for 10 minutes or more?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When visiting a new place, how often did the baby ...get excited about exploring new surroundings?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When visiting a new place, how often did the baby ...move about actively when s/he is exploring new surroundings?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When your baby was approached by an unfamiliar person when you and s/he were out (e.g., shopping), how often did the baby: ...show distress?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When your baby was approached by an unfamiliar person when you and s/he were out (e.g., shopping), how often did the baby: ...cry?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When an unfamiliar adult came to your home or flat, how often did your baby: ...allow her/himself to be picked up without protest?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When an unfamiliar adult came to your home or flat, how often did your baby: ...cry when the visitor attempted to pick her/him up?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When you returned from having been away and the baby was awake how often did s/he: ...smile or laugh?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When familiar relatives/friends visited, how often did the baby: ...get excited?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply

DURING THE PAST TWO WEEKS When familiar relatives/friends visited, how often did the baby: ...seem indifferent?

Please be sure to circle a number for every item.

1
Never
2
Very Rarely
3
Less Than Half the Time
4
About Half the Time
5
More Than Half the Time
6
Almost Always
7
Always
X
Does Not Apply
And finally, some questions about your child's feelings and behaviour...
Instructions: The form below contains statements about 12- to 35-month-old children. Many statements describe normal feelings and behaviours, but some statements describe feelings and behaviours that may be a problem. Please do your best to respond to every item.

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Shows pleasure when he/she succeeds (for example, claps for self)

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Gets hurt so often that you can't take your eyes off him or her

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Seems nervous, tense, or fearful

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Is restless and can't sit still

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Follows rules

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Wakes up at night and needs help to fall asleep again

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Cries or has tantrums until he or she is exhausted

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Is afraid of certain places, animals, or things. What is he or she afraid of?

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often
Generic text

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Has less fun than other children

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Looks for you (or other parent) when upset

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Cries or hangs onto you when you try to leave

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Worries a lot or is very serious

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Looks right at you when you say his or her name

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Does not react when hurt

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Is affectionate with loved ones

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Won't touch some objects because of how they feel

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Has trouble falling asleep or staying asleep

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Runs away in public places

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Plays well with other children (not including brother or sister)

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Can pay attention for a long time (other than watching TV)

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Has trouble adjusting to changes

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Tries to help when someone is hurt (for example, gives a toy)

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Often gets very upset

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Gags or chokes on food

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Imitates playful sounds when you ask him or her to

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Refuses to eat

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Hits, shoves, kicks, or bites children (not including brother or sister)

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Is destructive. Breaks or ruins things on purpose

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Points to show you something far away

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Hits, bites, or kicks you (or other parent)

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Hugs or feeds dolls or stuffed animals

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Seems very unhappy, sad, depressed or withdrawn

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH Purposely tries to hurt you (or other parent)

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the ONE response that best describes your child’s behaviour in the LAST MONTH When upset, gets very still, freezes, or doesn't move

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often
The following statements describe feelings and behaviours that can be problems for young children. Some of the descriptions may be a bit hard to understand, especially if you have not seen the behaviour in your child. Please do your best to respond to all statements.

Please circle the one response that best describes your child’s behaviour in the LAST MONTH Puts things in a special order over and over and gets upset if he/she is interrupted

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the one response that best describes your child’s behaviour in the LAST MONTH Repeats the same action or phrase over and over without enjoyment. Please give an example:

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often
Generic text

Please circle the one response that best describes your child’s behaviour in the LAST MONTH Repeats a particular movement over and over (like rocking, spinning). Please give an example:

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often
Generic text

Please circle the one response that best describes your child’s behaviour in the LAST MONTH Spaces out. Is totally unaware of what is happening around him or her

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the one response that best describes your child’s behaviour in the LAST MONTH Does not make eye contact

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the one response that best describes your child’s behaviour in the LAST MONTH Avoids physical contact

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often

Please circle the one response that best describes your child’s behaviour in the LAST MONTH Hurts self on purpose. (for example, bangs his or her head). Please give an example:

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often
Generic text

Please circle the one response that best describes your child’s behaviour in the LAST MONTH Eats or drinks things that are inedible (like paper or paint). Please give an example:

0
Not True/Rarely
1
Somewhat True/Sometimes
2
Very True/Often
Generic text

How worried are you about your child's behaviour, emotions, or relationships?

(Please circle a response)

1
Not at all worried
2
A little worried
3
Worried
4
Very Worried

How worried are you about your child's language development?

(Please circle a response)

1
Not at all worried
2
A little worried
3
Worried
4
Very Worried
And finally... What you were like when you were young?
When people become parents, they often think back on their own experiences when they were younger. We would like you to think about what you were like when you were young (before the age of 16 years). For each of the statements below, please tick a box to say whether this was Not True, Somewhat True or Certainly True for you back then.

What were you like when you were younger? I was considerate of other people's feelings

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I was restless and could not sit still for long

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I got a lot of headaches, stomach-aches or sickness

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I usually shared food, toys/games, DVDs etc., with other kids

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I got very angry and often lost my temper

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I was usually on my own. I generally played alone or kept to myself

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I usually did as I was told

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I worried a lot

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I was helpful if someone was hurt, upset, or feeling ill

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I was constantly fidgeting or squirming around

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I had at least one good friend

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I fought a lot.

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I was often unhappy, downhearted or tearful

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? Other people my age generally liked me

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I was easily distracted and found it difficult to concentrate

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I was nervous in new situations. I easily lost confidence

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I was kind to animals and younger children

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I was often accused of lying or cheating

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? Other kids picked on me or bullied me

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I often volunteered to help other people

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I thought things out before acting on them

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I took things that were not mine from home, school or shops

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I got on better with adults than with kids my own age

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I did graffiti or damaged property in other ways

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I had many fears, I was easily scared

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I saw tasks through to the end. My attention was good

1
Not True
2
Somewhat True
3
Certainly True

What were you like when you were younger? I played truant from school

1
Not True
2
Somewhat True
3
Certainly True

Overall, when you were younger (up to 16 years old) do you think that you had difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people?

1
No difficulties
2
Yes-minor difficulties
3
Yes-definite difficulties
4
Yes-severe difficulties
If you answered ‘Yes’, please answer the following questions about these difficulties:
qc_s17_28 == 2 || qc_s17_28 == 3 || qc_s17_28 == 4

How long were these difficulties present?

1
Less than a month
2
1-5 months
3
6-12 months
4
Over a year

Did the difficulties upset or distress you?

1
Not at all
2
Only a little
3
Quite a lot
4
A great deal

Did the difficulties interfere with your everyday life in the following areas? Homelife

1
Not at all
2
Only a little
3
Quite a lot
4
A great deal

Did the difficulties interfere with your everyday life in the following areas? Friendships

1
Not at all
2
Only a little
3
Quite a lot
4
A great deal

Did the difficulties interfere with your everyday life in the following areas? Classroom Learning

1
Not at all
2
Only a little
3
Quite a lot
4
A great deal

Did the difficulties interfere with your everyday life in the following areas? Leisure activities

1
Not at all
2
Only a little
3
Quite a lot
4
A great deal
Thank you for your help in completing this questionnaire and for all your time.
Part 3
Phase 8: PART 3 Wirral Child Health and Development Study

Date today:

Generic date
Emotional expression with my mother
Now think about yourself with your mother, and what happens when you show emotions with her, and how she usually behaves. Your behaviours are down the side, and hers are across the top of the table.

Circle the number that best fits, using the scale:

Get angry with me Be interested Show upset (e.g. crying) Talk calmly with me Show she was happy Be amused or find it funny

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

1 - Almost never

2 - Seldom

3 - Quite often

4 - Almost always

If I showed anger in an argument :
If I showed upset (e.g. crying):
If I talked about something that interests me:
If I talked about hopes for the future:
If I talked about something I found funny:
If I showed happiness over good news:
Your relationship with your partner..

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Handling Family finances

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Matters of recreation

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Religious matters

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Demonstrations of Affection

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Friends

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Sex relations

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Conventionality (correct or proper behaviour)

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Philosophy of life

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Ways of dealing with parents or in-laws

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Aims, goals and things believed important

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Amount of time spent together

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Making major decisions

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Household tasks

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Leisure time interests and activities

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Career decisions

1
Always agree
2
Almost always agree
3
Occasionally Disagree
4
Frequently Disagree
5
Almost Always Disagree
6
Always Disagree

How often do you discuss or have you considered divorce, separation, or terminating your relationship?

1
All of the time
2
Most of the time
3
More often than not
4
Occasionally
5
Rarely
6
Never

How often do you or your mate leave the house after a fight?

1
All of the time
2
Most of the time
3
More often than not
4
Occasionally
5
Rarely
6
Never

In general, how often do you think that things between you and your partner are going well?

1
All of the time
2
Most of the time
3
More often than not
4
Occasionally
5
Rarely
6
Never

Do you confide in your mate?

1
All of the time
2
Most of the time
3
More often than not
4
Occasionally
5
Rarely
6
Never

Do you ever regret that you married? (or lived together)

1
All of the time
2
Most of the time
3
More often than not
4
Occasionally
5
Rarely
6
Never

How often do you and your partner quarrel?

1
All of the time
2
Most of the time
3
More often than not
4
Occasionally
5
Rarely
6
Never

How often do you and your mate get on each other's nerves?

1
All of the time
2
Most of the time
3
More often than not
4
Occasionally
5
Rarely
6
Never

Do you kiss your mate?

1
Every Day
2
Almost Every Day
3
Occasionally
4
Rarely
5
Never

Do you and your mate engage in outside interests together?

1
Every Day
2
Almost Every Day
3
Occasionally
4
Rarely
5
Never

How often would you say the following events occur between you and your mate? Have a stimulating exchange of ideas

1
Never
2
Less than once a month
3
Once or twice a month
4
Once or twice a week
5
Once a day
6
More often

How often would you say the following events occur between you and your mate? Laugh together

1
Never
2
Less than once a month
3
Once or twice a month
4
Once or twice a week
5
Once a day
6
More often

How often would you say the following events occur between you and your mate? Calmly discuss something

1
Never
2
Less than once a month
3
Once or twice a month
4
Once or twice a week
5
Once a day
6
More often

How often would you say the following events occur between you and your mate? Work together on a project

1
Never
2
Less than once a month
3
Once or twice a month
4
Once or twice a week
5
Once a day
6
More often

These are some things about which couples sometimes agree and sometimes disagree. Indicate if either item below caused differences of opinions or were problems in your relationship during the past few weeks Being too tired for sex

(circle yes or no)

1
Yes
2
No

These are some things about which couples sometimes agree and sometimes disagree. Indicate if either item below caused differences of opinions or were problems in your relationship during the past few weeks Not showing love

(circle yes or no)

1
Yes
2
No

The dots on the following line represent different degrees of happiness in your relationship. The middle point, ‘happy’ represents the degree of happiness in most relationships. Please circle the dot which best describes the degree of happiness, all things considered, of your relationship

0
Extremely Unhappy
1
Fairly Unhappy
2
A Little Unhappy
3
Happy
4
Very Happy
5
Extremely Happy
6
Perfect

Which of the following statements best describe how you feel about the future of your relationship?

1
I want desperately for my relationship to succeed, and would go to almost any length to see that it does
2
I want very much for my relationship to succeed, and will do all that I can to see that it does
3
I want very much for my relationship to succeed, and will do my fair share to see that it does
4
It would be nice if my relationship succeeded, but I can’t do much more than I am doing now to help it succeed
5
It would be nice if it succeeded, but I refuse to do more than I am doing now to keep the relationship going
6
My relationship can never succeed, and there is no more that I can do to keep the relationship going

Since we last saw you, have YOU? Been supportive of your partner at a difficult time

1
Yes
2
No

Since we last saw you, have YOU? Just kept your opinions quietly to yourself

1
Yes
2
No

Since we last saw you, have YOU? Damaged a household item or some part of the home out of anger towards your partner

1
Yes
2
No

Since we last saw you, have YOU? Given your partner more affection to make up after an argument

1
Yes
2
No

Since we last saw you, have YOU? Deliberately disposed of or hid an important item of your partner's

1
Yes
2
No

Since we last saw you, have YOU? Got very upset if dinner, housework or home repair work was not done when you thought it should be

1
Yes
2
No

Since we last saw you, have YOU? Initiated a discussion to air (talk about) all points of view

1
Yes
2
No

Since we last saw you, have YOU? Purposely damaged or destroyed your partner's clothes, car or other personal possessions

1
Yes
2
No

Since we last saw you, have YOU? Insulted or shamed your partner in front of others

1
Yes
2
No

Since we last saw you, have YOU? Listened carefully to your partner

1
Yes
2
No

Since we last saw you, have YOU? Locked your partner out of the house

1
Yes
2
No

Since we last saw you, have YOU? Told your partner that he/she could not work or study

1
Yes
2
No

Since we last saw you, have YOU? Stated your position clearly

1
Yes
2
No

Since we last saw you, have YOU? Tried to stop your partner from seeing or talking to family or friends

1
Yes
2
No

Since we last saw you, have YOU? Been flexible about how you handle differences of opinion

1
Yes
2
No

Since we last saw you, have YOU? Repeated a point to make sure it was understood

1
Yes
2
No

Since we last saw you, have YOU? Restricted your partner's use of the car or telephone

1
Yes
2
No

Since we last saw you, have YOU? Made threats to leave the relationship

1
Yes
2
No

Since we last saw you, have YOU? Cooled down through physical work or activity

1
Yes
2
No

Since we last saw you, have YOU? Tried to turn family, friends, or children against your partner

1
Yes
2
No

Since we last saw you, have YOU? Given your partner helpful advice to solve a problem

1
Yes
2
No

Since we last saw you, have YOU? Ordered your partner around

1
Yes
2
No

Since we last saw you, have YOU? Tried new ways of dealing with problems together

1
Yes
2
No

Since we last saw you, have YOU? Admitted your faults or taken responsibility for a problem

1
Yes
2
No

Since we last saw you, have YOU? Frightened your partner

1
Yes
2
No

Since we last saw you, have YOU? Treated your partner like he/she was stupid

1
Yes
2
No

Since we last saw you, have YOU? Come up with helpful ideas for your partner

1
Yes
2
No

Since we last saw you, have YOU? Given in to your partner but planned revenge

1
Yes
2
No

Since we last saw you, have YOU? Brought in, or tried to bring in someone to help settle things

1
Yes
2
No

Since we last saw you, have YOU? Ridiculed your partner

1
Yes
2
No

Since we last saw you, have YOU? Expressed regret about something you did or said to your partner

1
Yes
2
No

Since we last saw you, have YOU? Threatened to hit your partner or throw something at him/her in anger

1
Yes
2
No

Since we last saw you, have YOU? Told your partner he/she was ugly or unattractive

1
Yes
2
No

Since we last saw you, have YOU? Been able to agree to a compromise over a problem

1
Yes
2
No

Since we last saw you, have YOU? Become abusive after using drugs or drinking alcohol

1
Yes
2
No

Since we last saw you, have YOU? Thrown, smashed, hit or kicked something in a disagreement

1
Yes
2
No

Since we last saw you, have YOU? Said sorry after an argument

1
Yes
2
No

Since we last saw you, have YOU? Agreed to disagree with your partner to settle an argument

1
Yes
2
No

Since we last saw you, have YOU? Agreed to go along with what your partner wanted

1
Yes
2
No

Since we last saw you, has YOUR PARTNER ? Been supportive of you at a difficult time

1
Yes
2
No

Since we last saw you, has YOUR PARTNER ? Just kept his/her opinions quiet

1
Yes
2
No

Since we last saw you, has YOUR PARTNER ? Damaged a household item or some part of the home out of anger towards you

1
Yes
2
No

Since we last saw you, has YOUR PARTNER ? Given you more affection to make up after an argument

1
Yes
2
No

Since we last saw you, has YOUR PARTNER ? Deliberately disposed of or hid an important item of yours

1
Yes
2
No

Since we last saw you, has YOUR PARTNER ? Got very upset if dinner, housework or home repair work was not done when he/she thought it should be

1
Yes
2
No