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Grounded Check-In for Parents

Child’s Age

Email

Over the past two weeks, how often has your child shown little interest or pleasure in doing things?

Over the past two weeks, how often has your child shown little interest or pleasure in doing things?
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D

Over the past two weeks, how often has your child felt down, depressed, or hopeless?

Over the past two weeks, how often has your child felt down, depressed, or hopeless?
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B
C
D

Over the past two weeks, has your child had trouble falling asleep, staying asleep, or sleeping too much?

Over the past two weeks, has your child had trouble falling asleep, staying asleep, or sleeping too much?
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B
C
D

Does your child struggle with transitions, showing intense emotional outbursts or total shut-downs when changing tasks?

Does your child struggle with transitions, showing intense emotional outbursts or total shut-downs when changing tasks?
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B
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D

Over the past two weeks, has your child's appetite or weight changed noticeably?

Over the past two weeks, has your child's appetite or weight changed noticeably?
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B
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D

Over the past two weeks, has your child often felt bad about themselves or like a failure?

Over the past two weeks, has your child often felt bad about themselves or like a failure?
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B
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D

Does your child struggle with age-appropriate social skills, such as sharing, cooperation, or resolving peer conflicts?

Does your child struggle with age-appropriate social skills, such as sharing, cooperation, or resolving peer conflicts?
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B
C
D

Over the past two weeks, has your child moved or spoken more slowly than usual, or been fidgety and restless?

Over the past two weeks, has your child moved or spoken more slowly than usual, or been fidgety and restless?
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B
C
D

Over the past two weeks, has your child thought about death or that they would be better off dead?

Over the past two weeks, has your child thought about death or that they would be better off dead?
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B
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D

How often does your child experience intense fear or worry that interferes with daily activities?

How often does your child experience intense fear or worry that interferes with daily activities?
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B
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D

Does your child avoid certain situations, like school or social events, due to anxiety?

Does your child avoid certain situations, like school or social events, due to anxiety?
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B
C
D

Has your child had sudden episodes of panic or intense fear?

Has your child had sudden episodes of panic or intense fear?
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B
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D

How well does your child get along with other children their age?

How well does your child get along with other children their age?
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B
C
D

Does your child bully others or get bullied by peers?

Does your child bully others or get bullied by peers?
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B
C
D

How is your child's behavior at school (e.g., following rules, completing tasks)?

How is your child's behavior at school (e.g., following rules, completing tasks)?
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B
C
D

Has your child shown aggressive behavior, like hitting or yelling?

Has your child shown aggressive behavior, like hitting or yelling?
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B
C
D

Does your child seem overly withdrawn or shy in social situations?

Does your child seem overly withdrawn or shy in social situations?
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B
C
D

How consistent is your child's eating routine?

How consistent is your child's eating routine?
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B
C
D

How would you rate your child's overall physical health?

How would you rate your child's overall physical health?
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B
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D

Has your child experienced any major stressful events recently (e.g., family changes, moves)?

Has your child experienced any major stressful events recently (e.g., family changes, moves)?
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B
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D

How often do you spend quality one-on-one time with your child?

How often do you spend quality one-on-one time with your child?
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B
C
D

On a scale of 1-5, how would you rate your child's emotional well-being?

On a scale of 1-5, how would you rate your child's emotional well-being?

Any prayer requests or additional comments about your child's mental health?