Child Behavior Patterns and Parent Concern Survey

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.

What is your child's current age range?

• 2-4 years
• 5-7 years
• 8-10 years
• 11-13 years
• 14-17 years

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

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

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

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)

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

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

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.

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

What is your relationship to the child?

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

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

• Boy
• Girl
• Non-binary / other
• Prefer not to say

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.