QuestionPunkQuestionPunk
無料で始める
すべてのテンプレート
Industry-Specific

Child Behavior Patterns and Parent Concern Survey

Captures how often common childhood behaviors (tantrums, defiance, anxiety, focus struggles, sleep issues) show up at home, school, and in public, and which ones worry parents most. An AI follow-up interview digs into the history and triggers behind the single behavior causing the most concern, going beyond a checkbox rating. Built for pediatric practices, school counselors, and parenting researchers.

このテンプレートを使うほかのテンプレートを見る

設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全13問・約7分
Q01
メッセージ

Thanks for taking a few minutes to share how your child has been doing lately. Your responses are completely confidential and anonymized. There are no right or wrong answers here — honest, everyday observations are the most useful. This should take about 5 minutes.

Q02
選択式必須

What is your child's current age range?

  • 2-4 years
  • 5-7 years
  • 8-10 years
  • 11-13 years
  • 14-17 years
Q03
マトリクス必須

In the last 30 days, how often has your child shown each of these behaviors?

7行 × 5列
  • Tantrums or meltdowns
  • Defiance or refusal to follow instructions
  • Aggression toward others (hitting, biting, pushing)
  • Anxiety or excessive worry
  • Difficulty focusing or sitting still
  • ほか2件
列: Never · Rarely (a few times a month) · Sometimes (weekly) · Often (several times a week) · Very often (daily)
Q04
オピニオンスケール必須

Overall, how manageable would you say your child's behavior has been recently?

スケール: 1 – 7
最小:Completely unmanageable最大:Very manageable
Q05
ベスト・ワースト選択（MaxDiff）必須

From the behaviors below, which is most concerning to you right now, and which concerns you least?

  • Tantrums or meltdowns
  • Defiance or refusal to follow instructions
  • Aggression toward others
  • Anxiety or excessive worry
  • Difficulty focusing or sitting still
  • Sleep problems
  • Screen time conflicts
各セットで最も良いもの・最も悪いものを選択最も良い:Most concerning最も悪い:Least concerning
Q06
選択式

In which settings does the behavior you're most concerned about tend to happen?

  • Home
  • School or daycare
  • Public places (stores, restaurants)
  • With peers or friends
  • During transitions (bedtime, leaving somewhere)
Q07
選択式

Which of these have you tried to address it?

  • Time-outs or consequences
  • Reward charts or incentives
  • Calmly talking it through
  • Ignoring the behavior
  • Consulted a pediatrician or counselor
  • Haven't tried anything specific yet
Q08
オピニオンスケール必須

How confident do you feel in your ability to manage this behavior when it happens?

スケール: 1 – 5
最小:Not at all confident最大:Extremely confident
Q09
AIインタビュー

Focus on the single behavior the respondent flagged as most concerning in the trade-off question. Ask when it first started or noticeably worsened, what tends to trigger it, and how it's changed over the last few months. Probe what they've already tried and whether it helped, made no difference, or backfired. If they mention a specific incident, ask them to walk through exactly what happened right before, during, and after it.

Q10
自由回答（長文）

Is there anything else about your child's behavior you'd like us to know that the questions above didn't cover?

Q11
選択式

What is your relationship to the child?

  • Parent or guardian
  • Grandparent
  • Other primary caregiver
  • Prefer not to say
Q12
選択式

Child's gender (optional, for grouping responses only)

  • Boy
  • Girl
  • Non-binary / other
  • Prefer not to say
Q13
メッセージ

Thank you for sharing these observations. Your responses help us understand common behavior patterns and build better support and follow-up conversations for families like yours.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • A matrix question tracks how often tantrums, defiance, anxiety, focus struggles, and sleep issues show up at home, school, and in public — not just a single overall rating.
  • A max-diff question pinpoints the single behavior causing the most concern, then an AI follow-up interview digs into its history and triggers, going beyond a checkbox or scale.
  • Opinion scales on manageability and confidence, plus multiple-choice on settings and prior attempts to address it, add context before the AI interview narrows in.
  • Built with pediatric practices, school counselors, and parenting researchers in mind, with an auto-generated report — on a platform with a free tier and $50/mo Business plan (no academic pricing tier).

SurveyMonkey

Behavior Surveys For Kids & Children

A fielding-ready template covering common childhood behavior questions, built on SurveyMonkey's mainstream survey platform. It's suited to general behavior tracking but relies on fixed question sets rather than any conversational follow-up. Best for teams that already use SurveyMonkey's broader survey and reporting tools.

優れている点

  • Quick to deploy using a large, well-known survey platform
  • Simple customization of question wording and answer choices
  • Built-in basic analytics and reporting dashboards

物足りない点

  • No adaptive AI follow-up to probe the history or triggers behind a specific concerning behavior
  • No voice AI interview option
  • No automated per-response quality scoring or transparent prompt methodology

Jotform

Child Concerns Report Form Template

A ready-to-use form for documenting concerns about a child, built on Jotform's drag-and-drop form builder. It's designed for structured intake/reporting rather than an in-depth conversation about why a behavior is happening. Useful for capturing a written summary of concerns, but branching is limited to static conditional logic.

優れている点

  • Easy to customize fields and layout without coding
  • Supports conditional logic to show/hide fields based on answers
  • Integrates with Jotform's wider form and workflow ecosystem

物足りない点

  • No adaptive AI interview to dig deeper into the most concerning behavior's history or triggers
  • No voice AI interview capability
  • No automated quality scoring of responses or auto-generated analysis report

よくあるご質問

「Child Behavior Patterns and Parent Concern Survey」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が13問含まれており、最初の設問は次のとおりです：「Thanks for taking a few minutes to share how your child has been doing lately. Your responses are completely confidentia…」・「What is your child's current age range?」・「In the last 30 days, how often has your child shown each of these behaviors?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、13問を約7分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

関連テンプレート

似たテーマのほかの調査もご覧ください。

すべて見る
Industry-Specific

Workplace Gender Inclusivity Experience Survey

Measures how included, fairly treated, and supported people of all genders feel at work — covering belonging, perceived fairness in promotions and pay, comfort reporting concerns, and which initiatives would help most — with an AI follow-up that surfaces the specific incidents and barriers behind the scores instead of vague sentiment. Built for HR, DEI, and people teams running culture pulse checks.

テンプレートを見る
Industry-Specific

Child Information & Enrollment Profile Survey

Collects the background, health, and behavioral information childcare centers, schools, and youth programs need to support a child well — routines, needs, and preferences alongside an AI follow-up that draws out the specific things a new caregiver should know on day one. Built for intake and enrollment teams.

テンプレートを見る
Industry-Specific

Daycare & Childcare Parent Satisfaction Survey

Measures how confident parents feel about their child's safety, how well the center communicates day-to-day, how warm staff feel toward kids, and whether developmental activities feel age-appropriate. An AI follow-up digs into the specific incident or gap behind any low safety or communication score, surfacing details a rating alone would miss.

テンプレートを見る
Industry-Specific

Parental Involvement and School Support Survey

Measures how confident and supported parents feel helping their child with schoolwork, which school resources they actually use, and where the biggest gaps are. Includes an AI follow-up interview that reconstructs a real recent moment of struggle to surface what support would have actually helped. Built for schools and PTAs planning parent-engagement programs.

テンプレートを見る
Industry-Specific

Childhood Trauma History and Present-Day Impact Survey

Screens for adverse childhood experiences and maps how they show up in adults' relationships, work, and daily wellbeing today. Built for therapists, researchers, and mental health programs running trauma-informed intake or research, with an AI follow-up that gently explores coping and resilience without pressuring anyone for details they'd rather not share.

テンプレートを見る
Industry-Specific

Pre-K to 12 Parent School Experience Survey

Measures how satisfied Pre-K through 12th grade parents are with their child's school across communication, safety, academic rigor, and teacher responsiveness, and shows what matters most to them when priorities compete. An AI follow-up interview digs into the specific experience behind their overall rating instead of just the number, for school leaders and PTA/district research teams.

テンプレートを見る