Physical Functioning Scale |
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1. It is hard for me to walk more than one block |
2. It is hard for me to run |
3. It is hard for me to do sports activity or exercise |
4. It is hard for me to lift something heavy |
5. It is hard for me to take a bath or shower by myself |
6. It is hard for me to do chores around the house |
7. I hurt or ache |
8. I have low energy |
Emotional Functioning Scale |
1. I feel afraid or scared |
2. I feel sad or blue |
3. I feel angry |
4. I have trouble sleeping |
5. I worry about what will happen to me |
Social Functioning Scale |
1. I have trouble getting along with other kids |
2. Other kids do not want to be my friend |
3. Other kids tease me |
4. I cannot do things that other kids my age can do |
5. It is hard to keep up when I play with other kids |
School Functioning Scale |
1. It is hard to pay attention in class |
2. I forget things |
3. I have trouble keeping up with my schoolwork |
4. I miss school because of not feeling well |
5. I miss school to go to the doctor or hospital |