Please answer this survey describing the behavior of your child. If you have more than one child, please describe your youngest child. This survey asks questions about your child’s engagement in aggressive behavior as well as art activities. Please be aware that a certain level of aggression in children is normal and healthy, and is no reason to feel embarrassed or distressed.

Child’s Date of Birth:

Male or Female:

Number of siblings:

To answer the following questions please select the number that is most appropriate for the behavior of your child by clicking respectively 1,2,3,4, or 5. 1 meaning that your child rarely participates in that activity, 2 meaning occasionally, 3 sometimes, 4 often, and 5 being very often.

Rarely, Occasionally, Sometimes, Often, Very Often

     1               2                 3                4          5

Your child gets in trouble at school for fist fights

1         2         3         4         5

Your child gets in trouble at school for bullying

1         2         3         4         5

Disputes with siblings become physical

1         2         3         4         5

Your child yells or swears at you

1         2         3         4         5

Your child yells or swears at siblings or peers

1         2         3         4         5

Your child yells at a teach or other caregiver other than a parent

1         2         3         4         5

Your child pulls others’ hair

1         2         3         4         5

Your child kicks you, teachers, or other adults

1         2         3         4         5

Your child kicks siblings or peers

1         2         3         4         5

Your child bites you, teachers, or other adults

1         2         3         4         5

Your child bites siblings or peers

1         2         3         4         5

Your child teases or taunts siblings or peers

1         2         3         4         5

Your child threatens to hurt you or others

1         2         3         4         5

Your child engages in violent play (pretending to injure, or kill)

1         2         3         4         5

Your child is aggressive with animals when around them

1         2         3         4         5

Your child intentionally damages property

1         2         3         4         5

Your child shows remorse/ apologizes after engaging in violent behavior

1         2         3         4         5

Your child takes pride in his/ her artwork

1         2         3         4         5

Your child focuses on his/ her artwork when at work

1         2         3         4         5

Your child tends to draw people

1         2         3         4         5

Your child puts forth effort on their artwork

1         2         3         4         5

Your child prefers art over most other activities such as reading, games, sports

1         2         3         4         5

Your child doodles during school (i.e., draws pictures in notebook or on school papers)

1         2         3         4         5

You or another caregiver engage your child in drawing/ painting/ sculpture at home

1         2         3         4         5

Your child engages in drawing/ painting/ sculpture at home independently

1         2         3         4         5

Your child engages in drawing/ painting/ sculpture at school

1         2         3         4         5

Your child uses art as a diversion when he/ she is upset

1         2         3         4         5

 

You have now completed the survey. Thank you for your participation!