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2013
November
V
Violent Parents, Violent Children?
Violent Parents, Violent Children?
Violent Parents, Violent Children? Please answer all questions truthfully. Thank you.
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What is your gender?
Male
Female
Who do you live with?
Mother
Father
Both
Other
Have you ever been spanked?
Yes
No
If so, at what age did it stop?
1-3
4-7
8-11
12-14
Other
Have you ever witnessed your mother or father being physically violent towards each other?
Hit
Push
Scratch
Punch
Kick
None
When you get angry do you …
Yell
Cry
Punch walls
Physically abuse another
Please answer truthfully to the following questions.
Yes
No
Have you ever been in trouble with the law?
Have you ever skipped school?
Have you ever stolen anything?
Have you ever experimented with drugs and alcohol?
Have you or your parent/guardian been diagnosed with a mental disorder?
Me
Mother
Father
Guardian
None
Have you ever been in an abusive relationship?
Yes
No
What is/was your relationship like with your parents?
Inadequate parental guidance and supervision
Equal parent-child relationship
You are/were forced to take on the role of the parent
None of the above
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