Incredible Years Registration and ATTENTIVE PARENTING® SURVEY

	Never	Rarely (Monthly)	Sometimes (Weekly)	Often (Daily)	Always (Several times a day)
How often do you engage in one-on-one play activities with your child?

When you play with your child, how likely are you to:

	Not at All Likely	Unlikely	Somewhat Likely	Likely	Very Likely
Allow your child to make decisions about what to play with
Get frustrated with your child’s ideas and activity level
Add structure and direction to play activities
Prepare your child for the end of playtime
Allow your child’s curiosity to direct play

If your child gets frustrated when learning new things, how likely are you to:

	Not at All Likely	Unlikely	Somewhat Likely	Likely	Very Likely
Support your child to continue trying
Promise your child a reward to continue
Let your child stop trying because it is hard to see your child upset
Warn that you will have to stop the activity
Raise your voice to get your child to focus
Finish the activity for your child

Which of the following methods do you use when teaching your child shapes, colors, letters, etc.:

	Never	Rarely	Sometimes	Often	Always
Ask questions, such as “What color is this?”
Describe items during play by color, shape, position or name of object.
Engage in story time to describe items and letters in the story
Use structured teaching time with specific learning activities, such as worksheets
Correct child’s mistakes

How likely are you to:

	Not at All Likely	Unlikely	Somewhat Likely	Likely	Very Likely
Use stories, pictures and games to teach your child about emotions
Encourage your child to share his/her feelings
Share your own negative feelings with your child
Use puppets and pretend play to teach your child about feelings
Encourage your child to think about others’ feelings
Give more attention to negative feelings than positive feelings
Label your own positive feelings throughout the day

When your child misbehaves, how likely are you to:

	Never	Rarely	Sometimes	Often	Always
Redirect your child to another activity
Ignore the misbehavior
Give this attention and instruct the child in better behavior
Stop the activity

How likely are you to:

	Not at All Likely	Unlikely	Somewhat Likely	Likely	Very Likely
Practice self-regulation strategies when your child is calm (e.g., deep breathing, counting, positive self-talk)
Use puppets to practice self-regulation strategies
Help your child identify his/her emotions by using words
Tell your child that he/she is “ok” or “fine” when upset or frustrated
Label your child’s positive emotions
Label your child’s negative emotions
Show your child you are angry by raising your voice or yelling
Pair talk about negative feelings with positive coping thoughts and feelings
Prompt your child to take deep breaths and use positive self-talk when beginning to get frustrated

How likely are you to:

	Not at All Likely	Unlikely	Somewhat Likely	Likely	Very Likely
Comment on social friendship skills when your child shares, waits, takes turns, apologizes or helps someone else
Provide opportunities for peer play dates so your child can practice social skills with another child
Give attention to your child’s negative social behaviors and correct them

How likely are you to:

	Never	Rarely	Sometimes	Often	Always
Use puppets and books to set up problem scenarios for your child to practice problem solving scenarios
Link your child’s experience of negative emotions with the problem solving process. “When you’re feeling sad that means you have a problem.”
Correct your child when brainstorming solutions to a problem
Model problem solving language yourself for your child to observe

Please select the degree to which you agree or disagree with the following items:

	Strongly Disagree	Disagree	Undecided	Agree	Strongly Agree
I am happy in my role as a parent.
Caring for my child(ren) sometimes takes more time and energy than I have to give.
I feel overwhelmed by the responsibility of being a parent.
I feel close to my child(ren).
I feel confident as a parent.

None	Milk	Eggs
Fish (e.g., bass, flounder, cod)	Crustacean shellfish (e.g., crab, lobster, shrimp)	Tree nuts (e.g., almonds, walnuts, pecans)
Peanuts	Wheat	Soybeans

None	Milk	Eggs
Fish (e.g., bass, flounder, cod)	Crustacean shellfish (e.g., crab, lobster, shrimp)	Tree nuts (e.g., almonds, walnuts, pecans)
Peanuts	Wheat	Soybeans