Fatigue Survey
Parent – Social Emotional
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Step
1
of 12
P1S) During an average school day, how often does your child seem emotionally exhausted?
0
% of the time.
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P2S) Which of these statements do you feel apply to your child when they are emotionally exhausted? Choose all that apply.
Gives up more easily
Acts out (Example: behaves badly, gets into arguments, yells or shouts)
Less motivated or has no desire to participate in class or do their schoolwork
Too tired to spend time with others
Wants to be alone
Avoids noisy areas
Withdraws from conversations
Other
I don’t know
If you selected other, type your response here.
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P3S) How do you know when your child is emotionally exhausted? Choose all that apply.
Becomes frustrated or irritable
Becomes impatient or angry
Becomes nervous or anxious
Becomes sad or depressed
Becomes sleepy or tired
Is less confident or their self-esteem is affected
Other
I don’t know
If you selected other, type your response here.
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P4S) What situations make your child feel emotionally exhausted? Choose all that apply.
When there are too many people talking around them (Example: big crowds)
Mishearing information or miscommunications
People not including them in conversations
People having side conversations
When they are in unfamiliar settings or social situations
When they have lots of things to do (Example: busy schedule)
Repeating themselves or asking others to repeat information
Other
I don’t know
If you selected other, type your response here.
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P5S) What does your child do when they are emotionally exhausted? Choose all that apply.
Stays away from the things that make them feel emotionally exhausted (Example: staying home from school, going to their room)
Takes a break (Example: closing eyes, turning off hearing aids or implants, eating or drinking something)
Finds distractions with things they enjoy (Example: listening to music, pulling out their phone)
Distracts others
Expresses their feelings
Doesn’t do anything
Tries to push through
Other
If you selected other, type your response here.
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P6S) When does your child seem emotionally exhausted? Choose all that apply.
At the beginning of the school day
During classes throughout the school day
During breaks throughout the school day
At the end of the school day
In the evening before bed
Other
They don’t ever seem to feel emotionally exhausted
If you selected other, type your response here.
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P7S) What strategies do you use to support your child when they are emotionally exhausted? Choose all that apply.
Encourage them to discuss/show their emotions
Acknowledge their emotions
Schedule activities when my child is less likely to be exhausted (Example: on the weekend versus after school)
Engage them in a calming activity (Example: colouring, meditating)
Other
I do not use any strategies
If you selected other, type your response here.
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P8S) At the end of the school day, how often does your child seem too emotionally exhausted to do after-school activities (playing sports, participating in clubs)?
0
% of the time
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P9S) At the end of the school day, how often does your child seem too emotionally exhausted to spend time with family?
0
% of the time
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P10S) How often does feeling emotionally exhausted affect your child's relationships with others?
0
% of the time
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P11S) When your child is emotionally exhausted, what situations are the most difficult for them to be in? Choose all that apply.
School activities or classes
Out of school activities
Social events
Family dinners or gatherings
Hanging out with friends
Other
If you selected other, type your response here.
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P12S) When your child is spending time with others, what do they do when they feel emotionally exhausted? Choose all that apply.
Hangs out with just a few people
Hangs out with just a few people
Pulls out their phone
Makes sure that they are in a spot where they can hear and see best
Leaves the situation
Pretends they understand what people are saying
Other
If you selected other, type your response here.
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