Core Assessment Measures

Attachment I3:
Core Assessment Measures (Rotating)

Research on the Efficacy and Feasibility of
Essentials for Parenting Toddlers and Preschoolers

Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention

Form Approved
OMB No. 0920-XXXX
Exp. Date xx/xx/20xx
Public reporting burden of this collection of information is estimated to average 15 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. An agency
may not conduct or sponsor, and a person is not required to respond to a collection of information unless
it displays a currently valid OMB control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden to
CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta,
Georgia 30333; ATTN: PRA (0920-XXXX).

Core Assessment Measures
Here is a list of behaviors that most young children do at least some times. Please indicate how often {ChildName} did each of them
in the past 7 days.

Rarely

In the past 7 days, how often did
{ChildName}…

Never

Some days

Most days

Every day

(less than
once)

(1-3 days)

(4-6 days)

(7 days)

Many times
each day

Choose not to
answer

Hit, kick, bite others

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Act hyperactive or noisy, run around

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Act non-compliant, defiant

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Yell, have temper tantrums

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Destroy things (damaging property)

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In the past week, how often did you do the following things when {ChildName} behaved well or did a good job at something?

When {ChildName} behaved well or did a good job at
something…
I praised or complimented {HIM/HER}
I gave {HIM/HER} a hug, kiss, pat, handshake, or “high five”
I gave {HIM/HER} something extra, like a small gift,
privileges, or a special activity with me

Attachment I3

Never

Rarely
(less than
once)

Some
days
(1-3 days)

Most
days
(4-6 days)

Every
day
(7 days)

Many
times
each day

Choose
not to
answer

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How many days last week did you…

have a special playtime with just you and {ChildName} ?
allow {ChildName} to take the lead when you played with
{HIM/HER}?
describe out loud and/or imitate what {ChildName} was
doing as you played with {HIM/HER}?

Attachment I3

Never

Rarely
(less than
once)

Some days
(1-3 days)

Most days
(4-6 days)

Every day
(7 days)

Many
times each
day

Choose
not to
answer

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In the last week…

I made clear distinctions between commands and
suggestions or questions.
I gave commands only once instead of repeating
them.
I used a consequence if {ChildName} refused to
comply with a command.

Attachment I3

Never

Seldom

Sometimes

Often

Always

0% of the time

About
25% of the
time

About
50% of the
time

About
75% of the
time

100% of the
time

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Choose not to
answer

How many days a week does {ChildName} …

get three meals, one in the morning, one around
noon, and one in the evening?
get a bath or shower at one particular time, known
as {HIS/HER} bath time?
go to bed at one particular time, known as
{HIS/HER} official bedtime?

Attachment I3

Never

Some days,
but less than
2 days a week

Between 2
and 3 days a
week

Between 4
and 5 days
a week

Not every
day, but
more than 5
days a week

All the time,
7 days a
week

Choose
not to
answer

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Rarely

How many times did you use a time-out with
{ChildName} in the past 7 days?

Attachment I3

Some days

Most days

Every day

Never

(less than
once)

(1-3 days)

(4-6 days)

(7 days)

Many times
each day

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Choose
not to
answer

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{If used time out}
When you used time-out in the past 7 days…

Never

Seldom

Sometimes

Often

Always
Choose
not to
answer

About

About

About

0% of the
time

25% of the
time

50% of the
time

75% of the
time

100% of the
time

You, not {ChildName} , decided when the time-out was over.

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The time-out location was away from other people (e.g.,
siblings), TV, games, toys, or other things {ChildName} likes.

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You avoided talking to, touching, and making eye contact with
{ChildName} while {HE/SHE} was in time out.

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Attachment I3