Survey 2 (respondents)

FROM FILE
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ATTACHMENT A3. SURVEY 1 AND 2 WD-FAB ITEMS

FIELD_NAME
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication

QUESTION
RESPONSE CHOICE
Please specify your level of agreement: I can keep up a conversation.
1
Please specify your level of agreement: I can keep up a conversation.
2
Please specify your level of agreement: I can keep up a conversation.
3
Please specify your level of agreement: I can keep up a conversation.
4
Please specify your level of agreement: I can keep up a conversation.
5
Please specify your level of agreement: I can keep up a conversation.
6
Are you able to wait your turn to speak?
1
Are you able to wait your turn to speak?
2
Are you able to wait your turn to speak?
3
Are you able to wait your turn to speak?
4
Are you able to wait your turn to speak?
5
Are you able to wait your turn to speak?
6
Are you able to discuss your ideas with others?
1
Are you able to discuss your ideas with others?
2
Are you able to discuss your ideas with others?
3
Are you able to discuss your ideas with others?
4
Are you able to discuss your ideas with others?
5
Are you able to discuss your ideas with others?
6
Are you able to make small talk?
1
Are you able to make small talk?
2
Are you able to make small talk?
3
Are you able to make small talk?
4
Are you able to make small talk?
5
Are you able to make small talk?
6
Are you able to figure out why a joke is funny?
1
Are you able to figure out why a joke is funny?
2
Are you able to figure out why a joke is funny?
3
Are you able to figure out why a joke is funny?
4
Are you able to figure out why a joke is funny?
5
Are you able to figure out why a joke is funny?
6
Please specify your level of agreement: I can follow what is being said when a grou1
Please specify your level of agreement: I can follow what is being said when a grou2
Please specify your level of agreement: I can follow what is being said when a grou3
Please specify your level of agreement: I can follow what is being said when a grou4
Please specify your level of agreement: I can follow what is being said when a grou5
Please specify your level of agreement: I can follow what is being said when a grou6
Please specify your level of agreement: I can follow what is being said when talkin 1
Please specify your level of agreement: I can follow what is being said when talkin 2
Please specify your level of agreement: I can follow what is being said when talkin 3
Please specify your level of agreement: I can follow what is being said when talkin 4
Please specify your level of agreement: I can follow what is being said when talkin 5
Please specify your level of agreement: I can follow what is being said when talkin 6
Are you able to understand body language and facial expressions when talking to 1
Are you able to understand body language and facial expressions when talking to 2
Are you able to understand body language and facial expressions when talking to 3
Are you able to understand body language and facial expressions when talking to 4
Are you able to understand body language and facial expressions when talking to 5
Are you able to understand body language and facial expressions when talking to 6
Please specify your level of agreement: I can understand simple instructions.
1
Please specify your level of agreement: I can understand simple instructions.
2
Please specify your level of agreement: I can understand simple instructions.
3
Please specify your level of agreement: I can understand simple instructions.
4
Please specify your level of agreement: I can understand simple instructions.
5
Please specify your level of agreement: I can understand simple instructions.
6
Are you able to understand what you hear on television?
1
Are you able to understand what you hear on television?
2
Are you able to understand what you hear on television?
3
Are you able to understand what you hear on television?
4
Are you able to understand what you hear on television?
5
Are you able to understand what you hear on television?
6
Are you able to pay attention when someone is talking to you for a short time? 1
Are you able to pay attention when someone is talking to you for a short time? 2
Are you able to pay attention when someone is talking to you for a short time? 3
Are you able to pay attention when someone is talking to you for a short time? 4
Are you able to pay attention when someone is talking to you for a short time? 5
Are you able to pay attention when someone is talking to you for a short time? 6
Are you able to pay attention when someone is talking to you for a long time?
1
Are you able to pay attention when someone is talking to you for a long time?
2
Are you able to pay attention when someone is talking to you for a long time?
3
Are you able to pay attention when someone is talking to you for a long time?
4
Are you able to pay attention when someone is talking to you for a long time?
5
Are you able to pay attention when someone is talking to you for a long time?
6
Are you able to understand people on the phone?
1
Are you able to understand people on the phone?
2
Are you able to understand people on the phone?
3
Are you able to understand people on the phone?
4
Are you able to understand people on the phone?
5
Are you able to understand people on the phone?
6
Are you able to understand people in noisy places?
1
Are you able to understand people in noisy places?
2
Are you able to understand people in noisy places?
3

RESPONSE TEXT
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty

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Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication

Are you able to understand people in noisy places?
4
Are you able to understand people in noisy places?
5
Are you able to understand people in noisy places?
6
Please specify your level of agreement: People can understand me when I talk.
1
Please specify your level of agreement: People can understand me when I talk.
2
Please specify your level of agreement: People can understand me when I talk.
3
Please specify your level of agreement: People can understand me when I talk.
4
Please specify your level of agreement: People can understand me when I talk.
5
Are you able to speak clearly?
1
Are you able to speak clearly?
2
Are you able to speak clearly?
3
Are you able to speak clearly?
4
Are you able to speak clearly?
5
Are you able to speak clearly?
6
Please specify your level of agreement: I am uncomfortable talking in a group.
1
Please specify your level of agreement: I am uncomfortable talking in a group.
2
Please specify your level of agreement: I am uncomfortable talking in a group.
3
Please specify your level of agreement: I am uncomfortable talking in a group.
4
Please specify your level of agreement: I am uncomfortable talking in a group.
5
Are you able to organize what you want to say?
1
Are you able to organize what you want to say?
2
Are you able to organize what you want to say?
3
Are you able to organize what you want to say?
4
Are you able to organize what you want to say?
5
Are you able to organize what you want to say?
6
Please specify your level of agreement: I have trouble finding the right word when 1
Please specify your level of agreement: I have trouble finding the right word when 2
Please specify your level of agreement: I have trouble finding the right word when 3
Please specify your level of agreement: I have trouble finding the right word when 4
Please specify your level of agreement: I have trouble finding the right word when 5
Are you able to get your point across when speaking with other people?
1
Are you able to get your point across when speaking with other people?
2
Are you able to get your point across when speaking with other people?
3
Are you able to get your point across when speaking with other people?
4
Are you able to get your point across when speaking with other people?
5
Are you able to get your point across when speaking with other people?
6
Are you able to give directions to another person?
1
Are you able to give directions to another person?
2
Are you able to give directions to another person?
3
Are you able to give directions to another person?
4
Are you able to give directions to another person?
5
Are you able to give directions to another person?
6
Are you able to get your point across when you are upset?
1
Are you able to get your point across when you are upset?
2
Are you able to get your point across when you are upset?
3
Are you able to get your point across when you are upset?
4
Are you able to get your point across when you are upset?
5
Are you able to get your point across when you are upset?
6
Are you able to tell a doctor about a health problem?
1
Are you able to tell a doctor about a health problem?
2
Are you able to tell a doctor about a health problem?
3
Are you able to tell a doctor about a health problem?
4
Are you able to tell a doctor about a health problem?
5
Are you able to tell a doctor about a health problem?
6
Are you able to remember the name of people you know when you see them?
1
Are you able to remember the name of people you know when you see them?
2
Are you able to remember the name of people you know when you see them?
3
Are you able to remember the name of people you know when you see them?
4
Are you able to remember the name of people you know when you see them?
5
Are you able to remember the name of people you know when you see them?
6
Are you able to get information you need when talking with people?
1
Are you able to get information you need when talking with people?
2
Are you able to get information you need when talking with people?
3
Are you able to get information you need when talking with people?
4
Are you able to get information you need when talking with people?
5
Are you able to get information you need when talking with people?
6
Are you able to tell others your needs? For example when you're tired and need to1
Are you able to tell others your needs? For example when you're tired and need to2
Are you able to tell others your needs? For example when you're tired and need to3
Are you able to tell others your needs? For example when you're tired and need to4
Are you able to tell others your needs? For example when you're tired and need to5
Are you able to tell others your needs? For example when you're tired and need to6
Are you able to use a computer to get in touch with someone?
1
Are you able to use a computer to get in touch with someone?
2
Are you able to use a computer to get in touch with someone?
3
Are you able to use a computer to get in touch with someone?
4
Are you able to use a computer to get in touch with someone?
5
Are you able to use a computer to get in touch with someone?
6
Are you able to hear people over the phone?
1
Are you able to hear people over the phone?
2
Are you able to hear people over the phone?
3
Are you able to hear people over the phone?
4
Are you able to hear people over the phone?
5

Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do

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Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
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Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
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Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication

Are you able to hear people over the phone?
6
Are you able to make an appointment over the phone? For example a haircut or d 1
Are you able to make an appointment over the phone? For example a haircut or d 2
Are you able to make an appointment over the phone? For example a haircut or d 3
Are you able to make an appointment over the phone? For example a haircut or d 4
Are you able to make an appointment over the phone? For example a haircut or d 5
Are you able to make an appointment over the phone? For example a haircut or d 6
Are you able to write reminder notes to yourself?
1
Are you able to write reminder notes to yourself?
2
Are you able to write reminder notes to yourself?
3
Are you able to write reminder notes to yourself?
4
Are you able to write reminder notes to yourself?
5
Are you able to write reminder notes to yourself?
6
Are you able to write a short email to someone?
1
Are you able to write a short email to someone?
2
Are you able to write a short email to someone?
3
Are you able to write a short email to someone?
4
Are you able to write a short email to someone?
5
Are you able to write a short email to someone?
6
Please specify your level of agreement: I often make mistakes when writing down 1
Please specify your level of agreement: I often make mistakes when writing down 2
Please specify your level of agreement: I often make mistakes when writing down 3
Please specify your level of agreement: I often make mistakes when writing down 4
Please specify your level of agreement: I often make mistakes when writing down 5
Please specify your level of agreement: I often misspell words.
1
Please specify your level of agreement: I often misspell words.
2
Please specify your level of agreement: I often misspell words.
3
Please specify your level of agreement: I often misspell words.
4
Please specify your level of agreement: I often misspell words.
5
Are you able to fill out applications?
1
Are you able to fill out applications?
2
Are you able to fill out applications?
3
Are you able to fill out applications?
4
Are you able to fill out applications?
5
Are you able to fill out applications?
6
Are you able to write your signature?
1
Are you able to write your signature?
2
Are you able to write your signature?
3
Are you able to write your signature?
4
Are you able to write your signature?
5
Are you able to write your signature?
6
Are you able to learn to do new things?
1
Are you able to learn to do new things?
2
Are you able to learn to do new things?
3
Are you able to learn to do new things?
4
Are you able to learn to do new things?
5
Are you able to learn to do new things?
6
Are you able to do two things at once?
1
Are you able to do two things at once?
2
Are you able to do two things at once?
3
Are you able to do two things at once?
4
Are you able to do two things at once?
5
Are you able to do two things at once?
6
Are you able to adjust to a new situation or change?
1
Are you able to adjust to a new situation or change?
2
Are you able to adjust to a new situation or change?
3
Are you able to adjust to a new situation or change?
4
Are you able to adjust to a new situation or change?
5
Are you able to adjust to a new situation or change?
6
Please specify your level of agreement: If I can't do something one way I will find a1
Please specify your level of agreement: If I can't do something one way I will find a2
Please specify your level of agreement: If I can't do something one way I will find a3
Please specify your level of agreement: If I can't do something one way I will find a4
Please specify your level of agreement: If I can't do something one way I will find a5
Please specify your level of agreement: If I can't do something one way I will find a6
Please specify your level of agreement: I am able to do my work carefully.
1
Please specify your level of agreement: I am able to do my work carefully.
2
Please specify your level of agreement: I am able to do my work carefully.
3
Please specify your level of agreement: I am able to do my work carefully.
4
Please specify your level of agreement: I am able to do my work carefully.
5
Please specify your level of agreement: I am able to do my work carefully.
6
Are you able to check that your bills are correct?
1
Are you able to check that your bills are correct?
2
Are you able to check that your bills are correct?
3
Are you able to check that your bills are correct?
4
Are you able to check that your bills are correct?
5
Are you able to check that your bills are correct?
6
Please specify your level of agreement: I have to work really hard to focus so I don1
Please specify your level of agreement: I have to work really hard to focus so I don2
Please specify your level of agreement: I have to work really hard to focus so I don3
Please specify your level of agreement: I have to work really hard to focus so I don4
Please specify your level of agreement: I have to work really hard to focus so I don5
Please specify your level of agreement: People often tell me I make mistakes in my1

I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree

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Cognition & Communication
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Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication

Please specify your level of agreement: People often tell me I make mistakes in my2
Please specify your level of agreement: People often tell me I make mistakes in my3
Please specify your level of agreement: People often tell me I make mistakes in my4
Please specify your level of agreement: People often tell me I make mistakes in my5
Are you able figure out the correct price for something that is on sale? For examp 1
Are you able figure out the correct price for something that is on sale? For examp 2
Are you able figure out the correct price for something that is on sale? For examp 3
Are you able figure out the correct price for something that is on sale? For examp 4
Are you able figure out the correct price for something that is on sale? For examp 5
Are you able figure out the correct price for something that is on sale? For examp 6
Please specify your level of agreement: I am able to add and subtract numbers in 1
Please specify your level of agreement: I am able to add and subtract numbers in 2
Please specify your level of agreement: I am able to add and subtract numbers in 3
Please specify your level of agreement: I am able to add and subtract numbers in 4
Please specify your level of agreement: I am able to add and subtract numbers in 5
Please specify your level of agreement: I am able to add and subtract numbers in 6
Are you able to finish things that you start?
1
Are you able to finish things that you start?
2
Are you able to finish things that you start?
3
Are you able to finish things that you start?
4
Are you able to finish things that you start?
5
Are you able to finish things that you start?
6
Are you able to finish things within a reasonable amount of time?
1
Are you able to finish things within a reasonable amount of time?
2
Are you able to finish things within a reasonable amount of time?
3
Are you able to finish things within a reasonable amount of time?
4
Are you able to finish things within a reasonable amount of time?
5
Are you able to finish things within a reasonable amount of time?
6
Please specify your level of agreement: When I have something easy to do, I have 1
Please specify your level of agreement: When I have something easy to do, I have 2
Please specify your level of agreement: When I have something easy to do, I have 3
Please specify your level of agreement: When I have something easy to do, I have 4
Please specify your level of agreement: When I have something easy to do, I have 5
Please specify your level of agreement: I am able to do many things at once.
1
Please specify your level of agreement: I am able to do many things at once.
2
Please specify your level of agreement: I am able to do many things at once.
3
Please specify your level of agreement: I am able to do many things at once.
4
Please specify your level of agreement: I am able to do many things at once.
5
Please specify your level of agreement: I am able to do many things at once.
6
Are you able to follow instructions given over the phone?
1
Are you able to follow instructions given over the phone?
2
Are you able to follow instructions given over the phone?
3
Are you able to follow instructions given over the phone?
4
Are you able to follow instructions given over the phone?
5
Are you able to follow instructions given over the phone?
6
Please specify your level of agreement: I am able to think clearly.
1
Please specify your level of agreement: I am able to think clearly.
2
Please specify your level of agreement: I am able to think clearly.
3
Please specify your level of agreement: I am able to think clearly.
4
Please specify your level of agreement: I am able to think clearly.
5
Please specify your level of agreement: I am able to think clearly.
6
Please specify your level of agreement: I have trouble putting my thoughts togeth 1
Please specify your level of agreement: I have trouble putting my thoughts togeth 2
Please specify your level of agreement: I have trouble putting my thoughts togeth 3
Please specify your level of agreement: I have trouble putting my thoughts togeth 4
Please specify your level of agreement: I have trouble putting my thoughts togeth 5
Are you able to think quickly?
1
Are you able to think quickly?
2
Are you able to think quickly?
3
Are you able to think quickly?
4
Are you able to think quickly?
5
Are you able to think quickly?
6
Please specify your level of agreement: I am easily confused when in a busy or noi 1
Please specify your level of agreement: I am easily confused when in a busy or noi 2
Please specify your level of agreement: I am easily confused when in a busy or noi 3
Please specify your level of agreement: I am easily confused when in a busy or noi 4
Please specify your level of agreement: I am easily confused when in a busy or noi 5
Please specify your level of agreement: I have trouble keeping my mind on what I 1
Please specify your level of agreement: I have trouble keeping my mind on what I 2
Please specify your level of agreement: I have trouble keeping my mind on what I 3
Please specify your level of agreement: I have trouble keeping my mind on what I 4
Please specify your level of agreement: I have trouble keeping my mind on what I 5
Are you able to pay attention for a long period of time?
1
Are you able to pay attention for a long period of time?
2
Are you able to pay attention for a long period of time?
3
Are you able to pay attention for a long period of time?
4
Are you able to pay attention for a long period of time?
5
Are you able to pay attention for a long period of time?
6
Are you able to keep track of what you need to do each day?
1
Are you able to keep track of what you need to do each day?
2
Are you able to keep track of what you need to do each day?
3
Are you able to keep track of what you need to do each day?
4
Are you able to keep track of what you need to do each day?
5

Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do

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117
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Cognition & Communication
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Cognition & Communication
Cognition & Communication

Are you able to keep track of what you need to do each day?
6
Are you able to use bank cards and automatic teller machines (ATMs)?
1
Are you able to use bank cards and automatic teller machines (ATMs)?
2
Are you able to use bank cards and automatic teller machines (ATMs)?
3
Are you able to use bank cards and automatic teller machines (ATMs)?
4
Are you able to use bank cards and automatic teller machines (ATMs)?
5
Are you able to use bank cards and automatic teller machines (ATMs)?
6
Are you able to work hard on tasks you don't like?
1
Are you able to work hard on tasks you don't like?
2
Are you able to work hard on tasks you don't like?
3
Are you able to work hard on tasks you don't like?
4
Are you able to work hard on tasks you don't like?
5
Are you able to work hard on tasks you don't like?
6
Are you able to do your regular chores?
1
Are you able to do your regular chores?
2
Are you able to do your regular chores?
3
Are you able to do your regular chores?
4
Are you able to do your regular chores?
5
Are you able to do your regular chores?
6
Please specify your level of agreement: I am good at following through with plans 1
Please specify your level of agreement: I am good at following through with plans 2
Please specify your level of agreement: I am good at following through with plans 3
Please specify your level of agreement: I am good at following through with plans 4
Please specify your level of agreement: I am good at following through with plans 5
Please specify your level of agreement: I am good at following through with plans 6
Please specify your level of agreement: I am able to make important decisions in m1
Please specify your level of agreement: I am able to make important decisions in m2
Please specify your level of agreement: I am able to make important decisions in m3
Please specify your level of agreement: I am able to make important decisions in m4
Please specify your level of agreement: I am able to make important decisions in m5
Please specify your level of agreement: I am able to make important decisions in m6
Are you able to make everyday decisions? For example what to wear, what to eat 1
Are you able to make everyday decisions? For example what to wear, what to eat 2
Are you able to make everyday decisions? For example what to wear, what to eat 3
Are you able to make everyday decisions? For example what to wear, what to eat 4
Are you able to make everyday decisions? For example what to wear, what to eat 5
Are you able to make everyday decisions? For example what to wear, what to eat 6
Are you able to think things through before making a decision?
1
Are you able to think things through before making a decision?
2
Are you able to think things through before making a decision?
3
Are you able to think things through before making a decision?
4
Are you able to think things through before making a decision?
5
Are you able to think things through before making a decision?
6
Are you able to recall information that you have always known?
1
Are you able to recall information that you have always known?
2
Are you able to recall information that you have always known?
3
Are you able to recall information that you have always known?
4
Are you able to recall information that you have always known?
5
Are you able to recall information that you have always known?
6
Are you able to remember things for a short time?
1
Are you able to remember things for a short time?
2
Are you able to remember things for a short time?
3
Are you able to remember things for a short time?
4
Are you able to remember things for a short time?
5
Are you able to remember things for a short time?
6
Are you able to remember something you read or heard earlier in the day?
1
Are you able to remember something you read or heard earlier in the day?
2
Are you able to remember something you read or heard earlier in the day?
3
Are you able to remember something you read or heard earlier in the day?
4
Are you able to remember something you read or heard earlier in the day?
5
Are you able to remember something you read or heard earlier in the day?
6
Please specify your level of agreement: I have trouble remembering important eve1
Please specify your level of agreement: I have trouble remembering important eve2
Please specify your level of agreement: I have trouble remembering important eve3
Please specify your level of agreement: I have trouble remembering important eve4
Please specify your level of agreement: I have trouble remembering important eve5
Are you able to remember a list of 4 or 5 errands without writing it down?
1
Are you able to remember a list of 4 or 5 errands without writing it down?
2
Are you able to remember a list of 4 or 5 errands without writing it down?
3
Are you able to remember a list of 4 or 5 errands without writing it down?
4
Are you able to remember a list of 4 or 5 errands without writing it down?
5
Are you able to remember a list of 4 or 5 errands without writing it down?
6
Please specify your level of agreement: I often have trouble keeping track of time. 1
Please specify your level of agreement: I often have trouble keeping track of time. 2
Please specify your level of agreement: I often have trouble keeping track of time. 3
Please specify your level of agreement: I often have trouble keeping track of time. 4
Please specify your level of agreement: I often have trouble keeping track of time. 5
Please specify your level of agreement: I often forget where I put things. For exam 1
Please specify your level of agreement: I often forget where I put things. For exam 2
Please specify your level of agreement: I often forget where I put things. For exam 3
Please specify your level of agreement: I often forget where I put things. For exam 4
Please specify your level of agreement: I often forget where I put things. For exam 5
Please specify your level of agreement: I often forget whether or not I did importa 1

I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree

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Cognition & Communication
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Cognition & Communication
Cognition & Communication
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Cognition & Communication
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Cognition & Communication
Cognition & Communication
Cognition & Communication
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Cognition & Communication
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Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication

Please specify your level of agreement: I often forget whether or not I did importa 2
Please specify your level of agreement: I often forget whether or not I did importa 3
Please specify your level of agreement: I often forget whether or not I did importa 4
Please specify your level of agreement: I often forget whether or not I did importa 5
Are you able to find your way around in unfamiliar places?
1
Are you able to find your way around in unfamiliar places?
2
Are you able to find your way around in unfamiliar places?
3
Are you able to find your way around in unfamiliar places?
4
Are you able to find your way around in unfamiliar places?
5
Are you able to find your way around in unfamiliar places?
6
Are you able to find your way around in familiar places?
1
Are you able to find your way around in familiar places?
2
Are you able to find your way around in familiar places?
3
Are you able to find your way around in familiar places?
4
Are you able to find your way around in familiar places?
5
Are you able to find your way around in familiar places?
6
Are you able to keep track of the day of the week?
1
Are you able to keep track of the day of the week?
2
Are you able to keep track of the day of the week?
3
Are you able to keep track of the day of the week?
4
Are you able to keep track of the day of the week?
5
Are you able to keep track of the day of the week?
6
Please specify your level of agreement: I am able to plan ahead for things that I wa1
Please specify your level of agreement: I am able to plan ahead for things that I wa2
Please specify your level of agreement: I am able to plan ahead for things that I wa3
Please specify your level of agreement: I am able to plan ahead for things that I wa4
Please specify your level of agreement: I am able to plan ahead for things that I wa5
Please specify your level of agreement: I am able to plan ahead for things that I wa6
Are you able to stay organized?
1
Are you able to stay organized?
2
Are you able to stay organized?
3
Are you able to stay organized?
4
Are you able to stay organized?
5
Are you able to stay organized?
6
Are you able to keep important papers organized? For example bills, insurance do 1
Are you able to keep important papers organized? For example bills, insurance do 2
Are you able to keep important papers organized? For example bills, insurance do 3
Are you able to keep important papers organized? For example bills, insurance do 4
Are you able to keep important papers organized? For example bills, insurance do 5
Are you able to keep important papers organized? For example bills, insurance do 6
Are you able to get to places on time?
1
Are you able to get to places on time?
2
Are you able to get to places on time?
3
Are you able to get to places on time?
4
Are you able to get to places on time?
5
Are you able to get to places on time?
6
Are you able to manage your time each day?
1
Are you able to manage your time each day?
2
Are you able to manage your time each day?
3
Are you able to manage your time each day?
4
Are you able to manage your time each day?
5
Are you able to manage your time each day?
6
Please specify your level of agreement: I notice my mistakes when they happen. 1
Please specify your level of agreement: I notice my mistakes when they happen. 2
Please specify your level of agreement: I notice my mistakes when they happen. 3
Please specify your level of agreement: I notice my mistakes when they happen. 4
Please specify your level of agreement: I notice my mistakes when they happen. 5
Please specify your level of agreement: I notice my mistakes when they happen. 6
Please specify your level of agreement: I am able to correct my mistakes when the 1
Please specify your level of agreement: I am able to correct my mistakes when the 2
Please specify your level of agreement: I am able to correct my mistakes when the 3
Please specify your level of agreement: I am able to correct my mistakes when the 4
Please specify your level of agreement: I am able to correct my mistakes when the 5
Please specify your level of agreement: I am able to correct my mistakes when the 6
Please specify your level of agreement: I am able to solve problems on my own. 1
Please specify your level of agreement: I am able to solve problems on my own. 2
Please specify your level of agreement: I am able to solve problems on my own. 3
Please specify your level of agreement: I am able to solve problems on my own. 4
Please specify your level of agreement: I am able to solve problems on my own. 5
Please specify your level of agreement: I am able to solve problems on my own. 6
Are you able to ask for help from others when difficult problems come up?
1
Are you able to ask for help from others when difficult problems come up?
2
Are you able to ask for help from others when difficult problems come up?
3
Are you able to ask for help from others when difficult problems come up?
4
Are you able to ask for help from others when difficult problems come up?
5
Are you able to ask for help from others when difficult problems come up?
6
Please specify your level of agreement: I have to read something several times to 1
Please specify your level of agreement: I have to read something several times to 2
Please specify your level of agreement: I have to read something several times to 3
Please specify your level of agreement: I have to read something several times to 4
Please specify your level of agreement: I have to read something several times to 5
Are you able to understand written instructions?
1
Are you able to understand written instructions?
2

Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty

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Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Cognition & Communication
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions

Are you able to understand written instructions?
3
Are you able to understand written instructions?
4
Are you able to understand written instructions?
5
Are you able to understand written instructions?
6
Please specify your level of agreement: I recognize danger when I see it.
1
Please specify your level of agreement: I recognize danger when I see it.
2
Please specify your level of agreement: I recognize danger when I see it.
3
Please specify your level of agreement: I recognize danger when I see it.
4
Please specify your level of agreement: I recognize danger when I see it.
5
Please specify your level of agreement: I recognize danger when I see it.
6
Please specify your level of agreement: I know what to do in case of an emergency1
Please specify your level of agreement: I know what to do in case of an emergency2
Please specify your level of agreement: I know what to do in case of an emergency3
Please specify your level of agreement: I know what to do in case of an emergency4
Please specify your level of agreement: I know what to do in case of an emergency5
Please specify your level of agreement: I know what to do in case of an emergency6
Are you able to follow public signs? For example STOP, DO NOT ENTER, EXIT.
1
Are you able to follow public signs? For example STOP, DO NOT ENTER, EXIT.
2
Are you able to follow public signs? For example STOP, DO NOT ENTER, EXIT.
3
Are you able to follow public signs? For example STOP, DO NOT ENTER, EXIT.
4
Are you able to follow public signs? For example STOP, DO NOT ENTER, EXIT.
5
Are you able to follow public signs? For example STOP, DO NOT ENTER, EXIT.
6
Are you able to keep yourself safe at home?
1
Are you able to keep yourself safe at home?
2
Are you able to keep yourself safe at home?
3
Are you able to keep yourself safe at home?
4
Are you able to keep yourself safe at home?
5
Are you able to keep yourself safe at home?
6
Please specify your level of agreement: I can follow what is being said when talkin 1
Please specify your level of agreement: I can follow what is being said when talkin 2
Please specify your level of agreement: I can follow what is being said when talkin 3
Please specify your level of agreement: I can follow what is being said when talkin 4
Please specify your level of agreement: I can follow what is being said when talkin 5
Please specify your level of agreement: I can follow what is being said when talkin 6
Are you able to use a computer to get information you need?
1
Are you able to use a computer to get information you need?
2
Are you able to use a computer to get information you need?
3
Are you able to use a computer to get information you need?
4
Are you able to use a computer to get information you need?
5
Are you able to use a computer to get information you need?
6
Are you able to talk to people over the phone?
1
Are you able to talk to people over the phone?
2
Are you able to talk to people over the phone?
3
Are you able to talk to people over the phone?
4
Are you able to talk to people over the phone?
5
Are you able to talk to people over the phone?
6
Please specify your level of agreement: I am easily distracted in a busy or noisy en 1
Please specify your level of agreement: I am easily distracted in a busy or noisy en 2
Please specify your level of agreement: I am easily distracted in a busy or noisy en 3
Please specify your level of agreement: I am easily distracted in a busy or noisy en 4
Please specify your level of agreement: I am easily distracted in a busy or noisy en 5
Are you able to remember important numbers? For example a phone number.
1
Are you able to remember important numbers? For example a phone number.
2
Are you able to remember important numbers? For example a phone number.
3
Are you able to remember important numbers? For example a phone number.
4
Are you able to remember important numbers? For example a phone number.
5
Are you able to remember important numbers? For example a phone number.
6
Please specify your level of agreement: It takes me a long time to run errands. For 1
Please specify your level of agreement: It takes me a long time to run errands. For 2
Please specify your level of agreement: It takes me a long time to run errands. For 3
Please specify your level of agreement: It takes me a long time to run errands. For 4
Please specify your level of agreement: It takes me a long time to run errands. For 5
Please specify your level of agreement: It takes me a long time to run errands. For 6
Are you able to take your medications correctly?
1
Are you able to take your medications correctly?
2
Are you able to take your medications correctly?
3
Are you able to take your medications correctly?
4
Are you able to take your medications correctly?
5
Are you able to take your medications correctly?
6
Are you able to keep your medical appointments?
1
Are you able to keep your medical appointments?
2
Are you able to keep your medical appointments?
3
Are you able to keep your medical appointments?
4
Are you able to keep your medical appointments?
5
Are you able to keep your medical appointments?
6
Please specify your level of agreement: I worry a lot about my health.
1
Please specify your level of agreement: I worry a lot about my health.
2
Please specify your level of agreement: I worry a lot about my health.
3
Please specify your level of agreement: I worry a lot about my health.
4
Please specify your level of agreement: I worry a lot about my health.
5
Please specify your level of agreement: I often think that something is really wron 1
Please specify your level of agreement: I often think that something is really wron 2
Please specify your level of agreement: I often think that something is really wron 3

Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Yes, without difficulty
Yes, with a little difficulty
Yes, with some difficulty
Yes, with a lot of difficulty
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree

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Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions

Please specify your level of agreement: I often think that something is really wron 4
Please specify your level of agreement: I often think that something is really wron 5
In the past 7 days, I felt hopeless about the future.
1
In the past 7 days, I felt hopeless about the future.
2
In the past 7 days, I felt hopeless about the future.
3
In the past 7 days, I felt hopeless about the future.
4
In the past 7 days, I felt hopeless about the future.
5
In the past 7 days, I felt hopeless about the future.
6
Please specify your level of agreement: I feel good about myself.
1
Please specify your level of agreement: I feel good about myself.
2
Please specify your level of agreement: I feel good about myself.
3
Please specify your level of agreement: I feel good about myself.
4
Please specify your level of agreement: I feel good about myself.
5
Please specify your level of agreement: I have a lot of energy.
1
Please specify your level of agreement: I have a lot of energy.
2
Please specify your level of agreement: I have a lot of energy.
3
Please specify your level of agreement: I have a lot of energy.
4
Please specify your level of agreement: I have a lot of energy.
5
In the past 7 days, I was bothered if I had to depend on others for help.
1
In the past 7 days, I was bothered if I had to depend on others for help.
2
In the past 7 days, I was bothered if I had to depend on others for help.
3
In the past 7 days, I was bothered if I had to depend on others for help.
4
In the past 7 days, I was bothered if I had to depend on others for help.
5
In the past 7 days, I was bothered if I had to depend on others for help.
6
In the past 7 days, I got fidgety. Hint: Fidgety meaning unable to sit still.
1
In the past 7 days, I got fidgety. Hint: Fidgety meaning unable to sit still.
2
In the past 7 days, I got fidgety. Hint: Fidgety meaning unable to sit still.
3
In the past 7 days, I got fidgety. Hint: Fidgety meaning unable to sit still.
4
In the past 7 days, I got fidgety. Hint: Fidgety meaning unable to sit still.
5
In the past 7 days, I got fidgety. Hint: Fidgety meaning unable to sit still.
6
Please specify your level of agreement: When I'm stressed, I can't figure out what 1
Please specify your level of agreement: When I'm stressed, I can't figure out what 2
Please specify your level of agreement: When I'm stressed, I can't figure out what 3
Please specify your level of agreement: When I'm stressed, I can't figure out what 4
Please specify your level of agreement: When I'm stressed, I can't figure out what 5
In the past 7 days, I was afraid of what the future holds for me.
1
In the past 7 days, I was afraid of what the future holds for me.
2
In the past 7 days, I was afraid of what the future holds for me.
3
In the past 7 days, I was afraid of what the future holds for me.
4
In the past 7 days, I was afraid of what the future holds for me.
5
In the past 7 days, I was afraid of what the future holds for me.
6
In the past 7 days, I felt something awful would happen.
1
In the past 7 days, I felt something awful would happen.
2
In the past 7 days, I felt something awful would happen.
3
In the past 7 days, I felt something awful would happen.
4
In the past 7 days, I felt something awful would happen.
5
In the past 7 days, I felt something awful would happen.
6
In the past 7 days, I felt nervous when my normal routine was disturbed.
1
In the past 7 days, I felt nervous when my normal routine was disturbed.
2
In the past 7 days, I felt nervous when my normal routine was disturbed.
3
In the past 7 days, I felt nervous when my normal routine was disturbed.
4
In the past 7 days, I felt nervous when my normal routine was disturbed.
5
In the past 7 days, I felt nervous when my normal routine was disturbed.
6
In the past 7 days, I felt indecisive. Hint: Indecisive meaning having trouble makin 1
In the past 7 days, I felt indecisive. Hint: Indecisive meaning having trouble makin 2
In the past 7 days, I felt indecisive. Hint: Indecisive meaning having trouble makin 3
In the past 7 days, I felt indecisive. Hint: Indecisive meaning having trouble makin 4
In the past 7 days, I felt indecisive. Hint: Indecisive meaning having trouble makin 5
In the past 7 days, I felt indecisive. Hint: Indecisive meaning having trouble makin 6
In the past 7 days, I had sudden feelings of panic.
1
In the past 7 days, I had sudden feelings of panic.
2
In the past 7 days, I had sudden feelings of panic.
3
In the past 7 days, I had sudden feelings of panic.
4
In the past 7 days, I had sudden feelings of panic.
5
In the past 7 days, I had sudden feelings of panic.
6
In the past 7 days, many situations made me worry.
1
In the past 7 days, many situations made me worry.
2
In the past 7 days, many situations made me worry.
3
In the past 7 days, many situations made me worry.
4
In the past 7 days, many situations made me worry.
5
In the past 7 days, many situations made me worry.
6
In the past 7 days, I felt that I had nothing to look forward to.
1
In the past 7 days, I felt that I had nothing to look forward to.
2
In the past 7 days, I felt that I had nothing to look forward to.
3
In the past 7 days, I felt that I had nothing to look forward to.
4
In the past 7 days, I felt that I had nothing to look forward to.
5
In the past 7 days, I felt that I had nothing to look forward to.
6
In the past 7 days, I felt that nothing was interesting.
1
In the past 7 days, I felt that nothing was interesting.
2
In the past 7 days, I felt that nothing was interesting.
3
In the past 7 days, I felt that nothing was interesting.
4
In the past 7 days, I felt that nothing was interesting.
5
In the past 7 days, I felt that nothing was interesting.
6

Strongly disagree
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know

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Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Mood & Emotions
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability

In the past 7 days, I felt that nothing could cheer me up.
In the past 7 days, I felt that nothing could cheer me up.
In the past 7 days, I felt that nothing could cheer me up.
In the past 7 days, I felt that nothing could cheer me up.
In the past 7 days, I felt that nothing could cheer me up.
In the past 7 days, I felt that nothing could cheer me up.
In the past 7 days, I was critical of myself for my mistakes.
In the past 7 days, I was critical of myself for my mistakes.
In the past 7 days, I was critical of myself for my mistakes.
In the past 7 days, I was critical of myself for my mistakes.
In the past 7 days, I was critical of myself for my mistakes.
In the past 7 days, I was critical of myself for my mistakes.
In the past 7 days, I felt emotionally exhausted.
In the past 7 days, I felt emotionally exhausted.
In the past 7 days, I felt emotionally exhausted.
In the past 7 days, I felt emotionally exhausted.
In the past 7 days, I felt emotionally exhausted.
In the past 7 days, I felt emotionally exhausted.
In the past 7 days, I had trouble enjoying the things I used to enjoy.
In the past 7 days, I had trouble enjoying the things I used to enjoy.
In the past 7 days, I had trouble enjoying the things I used to enjoy.
In the past 7 days, I had trouble enjoying the things I used to enjoy.
In the past 7 days, I had trouble enjoying the things I used to enjoy.
In the past 7 days, I had trouble enjoying the things I used to enjoy.
In the past 7 days, it was hard to keep up enthusiasm to get things done.
In the past 7 days, it was hard to keep up enthusiasm to get things done.
In the past 7 days, it was hard to keep up enthusiasm to get things done.
In the past 7 days, it was hard to keep up enthusiasm to get things done.
In the past 7 days, it was hard to keep up enthusiasm to get things done.
In the past 7 days, it was hard to keep up enthusiasm to get things done.
In the past 7 days, I was preoccupied with my worries.
In the past 7 days, I was preoccupied with my worries.
In the past 7 days, I was preoccupied with my worries.
In the past 7 days, I was preoccupied with my worries.
In the past 7 days, I was preoccupied with my worries.
In the past 7 days, I was preoccupied with my worries.
In the past 7 days, I had trouble paying attention.
In the past 7 days, I had trouble paying attention.
In the past 7 days, I had trouble paying attention.
In the past 7 days, I had trouble paying attention.
In the past 7 days, I had trouble paying attention.
In the past 7 days, I had trouble paying attention.
In the past 7 days, it was hard to adjust to unexpected changes.
In the past 7 days, it was hard to adjust to unexpected changes.
In the past 7 days, it was hard to adjust to unexpected changes.
In the past 7 days, it was hard to adjust to unexpected changes.
In the past 7 days, it was hard to adjust to unexpected changes.
In the past 7 days, it was hard to adjust to unexpected changes.
In the past 7 days, just being around people irritated me.
In the past 7 days, just being around people irritated me.
In the past 7 days, just being around people irritated me.
In the past 7 days, just being around people irritated me.
In the past 7 days, just being around people irritated me.
In the past 7 days, just being around people irritated me.
In the past 7 days, I had trouble keeping in touch with others.
In the past 7 days, I had trouble keeping in touch with others.
In the past 7 days, I had trouble keeping in touch with others.
In the past 7 days, I had trouble keeping in touch with others.
In the past 7 days, I had trouble keeping in touch with others.
In the past 7 days, I had trouble keeping in touch with others.
In the past 7 days, I avoided public places or activities.
In the past 7 days, I avoided public places or activities.
In the past 7 days, I avoided public places or activities.
In the past 7 days, I avoided public places or activities.
In the past 7 days, I avoided public places or activities.
In the past 7 days, I avoided public places or activities.
Please specify your level of agreement: I can handle stressful situations.
Please specify your level of agreement: I can handle stressful situations.
Please specify your level of agreement: I can handle stressful situations.
Please specify your level of agreement: I can handle stressful situations.
Please specify your level of agreement: I can handle stressful situations.
Please specify your level of agreement: I usually accomplish what I set out to do.
Please specify your level of agreement: I usually accomplish what I set out to do.
Please specify your level of agreement: I usually accomplish what I set out to do.
Please specify your level of agreement: I usually accomplish what I set out to do.
Please specify your level of agreement: I usually accomplish what I set out to do.
Please specify your level of agreement: I ask for help when I need to.
Please specify your level of agreement: I ask for help when I need to.
Please specify your level of agreement: I ask for help when I need to.
Please specify your level of agreement: I ask for help when I need to.
Please specify your level of agreement: I ask for help when I need to.
Please specify your level of agreement: I don't mind when people give me advice.
Please specify your level of agreement: I don't mind when people give me advice.

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I don't know
Never
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I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree

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Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability

Please specify your level of agreement: I don't mind when people give me advice. 3
Please specify your level of agreement: I don't mind when people give me advice. 4
Please specify your level of agreement: I don't mind when people give me advice. 5
Please specify your level of agreement: I am able to adjust to other people's ways. 1
Please specify your level of agreement: I am able to adjust to other people's ways. 2
Please specify your level of agreement: I am able to adjust to other people's ways. 3
Please specify your level of agreement: I am able to adjust to other people's ways. 4
Please specify your level of agreement: I am able to adjust to other people's ways. 5
Please specify your level of agreement: I make an effort to get to know other peop1
Please specify your level of agreement: I make an effort to get to know other peop2
Please specify your level of agreement: I make an effort to get to know other peop3
Please specify your level of agreement: I make an effort to get to know other peop4
Please specify your level of agreement: I make an effort to get to know other peop5
Please specify your level of agreement: I always try to get along with others.
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Please specify your level of agreement: I always try to get along with others.
2
Please specify your level of agreement: I always try to get along with others.
3
Please specify your level of agreement: I always try to get along with others.
4
Please specify your level of agreement: I always try to get along with others.
5
Please specify your level of agreement: I work well in a group.
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Please specify your level of agreement: I work well in a group.
2
Please specify your level of agreement: I work well in a group.
3
Please specify your level of agreement: I work well in a group.
4
Please specify your level of agreement: I work well in a group.
5
Please specify your level of agreement: I am not easily discouraged.
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Please specify your level of agreement: I am not easily discouraged.
2
Please specify your level of agreement: I am not easily discouraged.
3
Please specify your level of agreement: I am not easily discouraged.
4
Please specify your level of agreement: I am not easily discouraged.
5
Please specify your level of agreement: I am good at getting to know new people. 1
Please specify your level of agreement: I am good at getting to know new people. 2
Please specify your level of agreement: I am good at getting to know new people. 3
Please specify your level of agreement: I am good at getting to know new people. 4
Please specify your level of agreement: I am good at getting to know new people. 5
Please specify your level of agreement: I can admit my mistakes.
1
Please specify your level of agreement: I can admit my mistakes.
2
Please specify your level of agreement: I can admit my mistakes.
3
Please specify your level of agreement: I can admit my mistakes.
4
Please specify your level of agreement: I can admit my mistakes.
5
Please specify your level of agreement: When there is a problem I am able to work1
Please specify your level of agreement: When there is a problem I am able to work2
Please specify your level of agreement: When there is a problem I am able to work3
Please specify your level of agreement: When there is a problem I am able to work4
Please specify your level of agreement: When there is a problem I am able to work5
Please specify your level of agreement: When there is a problem I am able to work6
Please specify your level of agreement: I get along well with people outside my fam1
Please specify your level of agreement: I get along well with people outside my fam2
Please specify your level of agreement: I get along well with people outside my fam3
Please specify your level of agreement: I get along well with people outside my fam4
Please specify your level of agreement: I get along well with people outside my fam5
Please specify your level of agreement: I feel that there are people I can turn to. 1
Please specify your level of agreement: I feel that there are people I can turn to. 2
Please specify your level of agreement: I feel that there are people I can turn to. 3
Please specify your level of agreement: I feel that there are people I can turn to. 4
Please specify your level of agreement: I feel that there are people I can turn to. 5
Please specify your level of agreement: I respect other people's point of view.
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Please specify your level of agreement: I respect other people's point of view.
2
Please specify your level of agreement: I respect other people's point of view.
3
Please specify your level of agreement: I respect other people's point of view.
4
Please specify your level of agreement: I respect other people's point of view.
5
Please specify your level of agreement: It's easy to do what people in authority as 1
Please specify your level of agreement: It's easy to do what people in authority as 2
Please specify your level of agreement: It's easy to do what people in authority ask3
Please specify your level of agreement: It's easy to do what people in authority ask4
Please specify your level of agreement: It's easy to do what people in authority ask5
Please specify your level of agreement: I am good at making new friends.
1
Please specify your level of agreement: I am good at making new friends.
2
Please specify your level of agreement: I am good at making new friends.
3
Please specify your level of agreement: I am good at making new friends.
4
Please specify your level of agreement: I am good at making new friends.
5
Please specify your level of agreement: I'm comfortable trying different ways to d 1
Please specify your level of agreement: I'm comfortable trying different ways to d 2
Please specify your level of agreement: I'm comfortable trying different ways to d 3
Please specify your level of agreement: I'm comfortable trying different ways to d 4
Please specify your level of agreement: I'm comfortable trying different ways to d 5
Please specify your level of agreement: When I'm asked to do a really difficult task 1
Please specify your level of agreement: When I'm asked to do a really difficult task 2
Please specify your level of agreement: When I'm asked to do a really difficult task 3
Please specify your level of agreement: When I'm asked to do a really difficult task 4
Please specify your level of agreement: When I'm asked to do a really difficult task 5
Please specify your level of agreement: If I make a mistake, I know I can deal with 1
Please specify your level of agreement: If I make a mistake, I know I can deal with 2
Please specify your level of agreement: If I make a mistake, I know I can deal with 3
Please specify your level of agreement: If I make a mistake, I know I can deal with 4

Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
Unable to do
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree

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Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Resilience & Sociability
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation

Please specify your level of agreement: If I make a mistake, I know I can deal with 5
Please specify your level of agreement: I think people trust me.
1
Please specify your level of agreement: I think people trust me.
2
Please specify your level of agreement: I think people trust me.
3
Please specify your level of agreement: I think people trust me.
4
Please specify your level of agreement: I think people trust me.
5
Please specify your level of agreement: I look at both sides of an issue.
1
Please specify your level of agreement: I look at both sides of an issue.
2
Please specify your level of agreement: I look at both sides of an issue.
3
Please specify your level of agreement: I look at both sides of an issue.
4
Please specify your level of agreement: I look at both sides of an issue.
5
Please specify your level of agreement: I am willing to accept help from others. 1
Please specify your level of agreement: I am willing to accept help from others. 2
Please specify your level of agreement: I am willing to accept help from others. 3
Please specify your level of agreement: I am willing to accept help from others. 4
Please specify your level of agreement: I am willing to accept help from others. 5
Please specify your level of agreement: I am comfortable making eye contact with 1
Please specify your level of agreement: I am comfortable making eye contact with 2
Please specify your level of agreement: I am comfortable making eye contact with 3
Please specify your level of agreement: I am comfortable making eye contact with 4
Please specify your level of agreement: I am comfortable making eye contact with 5
Please specify your level of agreement: I can get back on track when I am distracte1
Please specify your level of agreement: I can get back on track when I am distracte2
Please specify your level of agreement: I can get back on track when I am distracte3
Please specify your level of agreement: I can get back on track when I am distracte4
Please specify your level of agreement: I can get back on track when I am distracte5
Please specify your level of agreement: I like large family gatherings.
1
Please specify your level of agreement: I like large family gatherings.
2
Please specify your level of agreement: I like large family gatherings.
3
Please specify your level of agreement: I like large family gatherings.
4
Please specify your level of agreement: I like large family gatherings.
5
Please specify your level of agreement: People tell me I'm flexible and agreeable. 1
Please specify your level of agreement: People tell me I'm flexible and agreeable. 2
Please specify your level of agreement: People tell me I'm flexible and agreeable. 3
Please specify your level of agreement: People tell me I'm flexible and agreeable. 4
Please specify your level of agreement: People tell me I'm flexible and agreeable. 5
Please specify your level of agreement: Most people like what I have to say.
1
Please specify your level of agreement: Most people like what I have to say.
2
Please specify your level of agreement: Most people like what I have to say.
3
Please specify your level of agreement: Most people like what I have to say.
4
Please specify your level of agreement: Most people like what I have to say.
5
Please specify your level of agreement: I'm usually able to help solve other people 1
Please specify your level of agreement: I'm usually able to help solve other people 2
Please specify your level of agreement: I'm usually able to help solve other people 3
Please specify your level of agreement: I'm usually able to help solve other people 4
Please specify your level of agreement: I'm usually able to help solve other people 5
Please specify your level of agreement: I'm comfortable just seeing what the day b1
Please specify your level of agreement: I'm comfortable just seeing what the day b2
Please specify your level of agreement: I'm comfortable just seeing what the day b3
Please specify your level of agreement: I'm comfortable just seeing what the day b4
Please specify your level of agreement: I'm comfortable just seeing what the day b5
Please specify your level of agreement: I look for the good in difficult situations. 1
Please specify your level of agreement: I look for the good in difficult situations. 2
Please specify your level of agreement: I look for the good in difficult situations. 3
Please specify your level of agreement: I look for the good in difficult situations. 4
Please specify your level of agreement: I look for the good in difficult situations. 5
Please specify your level of agreement: I believe that things end up alright most of 1
Please specify your level of agreement: I believe that things end up alright most of 2
Please specify your level of agreement: I believe that things end up alright most of 3
Please specify your level of agreement: I believe that things end up alright most of 4
Please specify your level of agreement: I believe that things end up alright most of 5
Please specify your level of agreement: Sometimes I do things to hurt myself.
1
Please specify your level of agreement: Sometimes I do things to hurt myself.
2
Please specify your level of agreement: Sometimes I do things to hurt myself.
3
Please specify your level of agreement: Sometimes I do things to hurt myself.
4
Please specify your level of agreement: Sometimes I do things to hurt myself.
5
Please specify your level of agreement: I often get angry when I'm told what to do 1
Please specify your level of agreement: I often get angry when I'm told what to do 2
Please specify your level of agreement: I often get angry when I'm told what to do 3
Please specify your level of agreement: I often get angry when I'm told what to do 4
Please specify your level of agreement: I often get angry when I'm told what to do 5
Please specify your level of agreement: I often get upset with the people around m1
Please specify your level of agreement: I often get upset with the people around m2
Please specify your level of agreement: I often get upset with the people around m3
Please specify your level of agreement: I often get upset with the people around m4
Please specify your level of agreement: I often get upset with the people around m5
Please specify your level of agreement: I am always watching or on guard for threa1
Please specify your level of agreement: I am always watching or on guard for threa2
Please specify your level of agreement: I am always watching or on guard for threa3
Please specify your level of agreement: I am always watching or on guard for threa4
Please specify your level of agreement: I am always watching or on guard for threa5
Please specify your level of agreement: I have difficulty following the rules.
1
Please specify your level of agreement: I have difficulty following the rules.
2

I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree

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Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation

Please specify your level of agreement: I have difficulty following the rules.
3
Please specify your level of agreement: I have difficulty following the rules.
4
Please specify your level of agreement: I have difficulty following the rules.
5
Please specify your level of agreement: I have difficulty calming down.
1
Please specify your level of agreement: I have difficulty calming down.
2
Please specify your level of agreement: I have difficulty calming down.
3
Please specify your level of agreement: I have difficulty calming down.
4
Please specify your level of agreement: I have difficulty calming down.
5
Please specify your level of agreement: Sometimes I feel on top of the world for n 1
Please specify your level of agreement: Sometimes I feel on top of the world for n 2
Please specify your level of agreement: Sometimes I feel on top of the world for n 3
Please specify your level of agreement: Sometimes I feel on top of the world for n 4
Please specify your level of agreement: Sometimes I feel on top of the world for n 5
Please specify your level of agreement: I find that I have a hard time sitting still wh1
Please specify your level of agreement: I find that I have a hard time sitting still wh2
Please specify your level of agreement: I find that I have a hard time sitting still wh3
Please specify your level of agreement: I find that I have a hard time sitting still wh4
Please specify your level of agreement: I find that I have a hard time sitting still wh5
Please specify your level of agreement: The same thoughts keep running through 1
Please specify your level of agreement: The same thoughts keep running through 2
Please specify your level of agreement: The same thoughts keep running through 3
Please specify your level of agreement: The same thoughts keep running through 4
Please specify your level of agreement: The same thoughts keep running through 5
Please specify your level of agreement: When I am stressed, I find myself losing co1
Please specify your level of agreement: When I am stressed, I find myself losing co2
Please specify your level of agreement: When I am stressed, I find myself losing co3
Please specify your level of agreement: When I am stressed, I find myself losing co4
Please specify your level of agreement: When I am stressed, I find myself losing co5
Please specify your level of agreement: I seem to worry about my health a lot.
1
Please specify your level of agreement: I seem to worry about my health a lot.
2
Please specify your level of agreement: I seem to worry about my health a lot.
3
Please specify your level of agreement: I seem to worry about my health a lot.
4
Please specify your level of agreement: I seem to worry about my health a lot.
5
Please specify your level of agreement: People say I show no emotion.
1
Please specify your level of agreement: People say I show no emotion.
2
Please specify your level of agreement: People say I show no emotion.
3
Please specify your level of agreement: People say I show no emotion.
4
Please specify your level of agreement: People say I show no emotion.
5
Please specify your level of agreement: I often have difficulty dealing with people. 1
Please specify your level of agreement: I often have difficulty dealing with people. 2
Please specify your level of agreement: I often have difficulty dealing with people. 3
Please specify your level of agreement: I often have difficulty dealing with people. 4
Please specify your level of agreement: I often have difficulty dealing with people. 5
Please specify your level of agreement: I have a hard time accepting criticism.
1
Please specify your level of agreement: I have a hard time accepting criticism.
2
Please specify your level of agreement: I have a hard time accepting criticism.
3
Please specify your level of agreement: I have a hard time accepting criticism.
4
Please specify your level of agreement: I have a hard time accepting criticism.
5
Please specify your level of agreement: People have told me that sometimes I act 1
Please specify your level of agreement: People have told me that sometimes I act 2
Please specify your level of agreement: People have told me that sometimes I act 3
Please specify your level of agreement: People have told me that sometimes I act 4
Please specify your level of agreement: People have told me that sometimes I act 5
Please specify your level of agreement: I often say things that upset others.
1
Please specify your level of agreement: I often say things that upset others.
2
Please specify your level of agreement: I often say things that upset others.
3
Please specify your level of agreement: I often say things that upset others.
4
Please specify your level of agreement: I often say things that upset others.
5
Please specify your level of agreement: I have difficulty letting people know how I 1
Please specify your level of agreement: I have difficulty letting people know how I 2
Please specify your level of agreement: I have difficulty letting people know how I 3
Please specify your level of agreement: I have difficulty letting people know how I 4
Please specify your level of agreement: I have difficulty letting people know how I 5
Please specify your level of agreement: I respect other people's property.
1
Please specify your level of agreement: I respect other people's property.
2
Please specify your level of agreement: I respect other people's property.
3
Please specify your level of agreement: I respect other people's property.
4
Please specify your level of agreement: I respect other people's property.
5
Please specify your level of agreement: I am able to work toward long term goals. 1
Please specify your level of agreement: I am able to work toward long term goals. 2
Please specify your level of agreement: I am able to work toward long term goals. 3
Please specify your level of agreement: I am able to work toward long term goals. 4
Please specify your level of agreement: I am able to work toward long term goals. 5
Please specify your level of agreement: People tell me I stand too close when I am 1
Please specify your level of agreement: People tell me I stand too close when I am 2
Please specify your level of agreement: People tell me I stand too close when I am 3
Please specify your level of agreement: People tell me I stand too close when I am 4
Please specify your level of agreement: People tell me I stand too close when I am 5
Please specify your level of agreement: When I have something hard to do, I have 1
Please specify your level of agreement: When I have something hard to do, I have 2
Please specify your level of agreement: When I have something hard to do, I have 3
Please specify your level of agreement: When I have something hard to do, I have 4
Please specify your level of agreement: When I have something hard to do, I have 5

Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know

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Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation
Self-Regulation

Please specify your level of agreement: Others have told me that I do things that p1
Please specify your level of agreement: Others have told me that I do things that p2
Please specify your level of agreement: Others have told me that I do things that p3
Please specify your level of agreement: Others have told me that I do things that p4
Please specify your level of agreement: Others have told me that I do things that p5
Please specify your level of agreement: I feel people are against me.
1
Please specify your level of agreement: I feel people are against me.
2
Please specify your level of agreement: I feel people are against me.
3
Please specify your level of agreement: I feel people are against me.
4
Please specify your level of agreement: I feel people are against me.
5
Please specify your level of agreement: I get very loud when I do not get what I wa1
Please specify your level of agreement: I get very loud when I do not get what I wa2
Please specify your level of agreement: I get very loud when I do not get what I wa3
Please specify your level of agreement: I get very loud when I do not get what I wa4
Please specify your level of agreement: I get very loud when I do not get what I wa5
Please specify your level of agreement: I sometimes get physical when I'm angry. 1
Please specify your level of agreement: I sometimes get physical when I'm angry. 2
Please specify your level of agreement: I sometimes get physical when I'm angry. 3
Please specify your level of agreement: I sometimes get physical when I'm angry. 4
Please specify your level of agreement: I sometimes get physical when I'm angry. 5
Please specify your level of agreement: Sometimes I shout or yell for no reason. 1
Please specify your level of agreement: Sometimes I shout or yell for no reason. 2
Please specify your level of agreement: Sometimes I shout or yell for no reason. 3
Please specify your level of agreement: Sometimes I shout or yell for no reason. 4
Please specify your level of agreement: Sometimes I shout or yell for no reason. 5
Please specify your level of agreement: People know that I get angry easily.
1
Please specify your level of agreement: People know that I get angry easily.
2
Please specify your level of agreement: People know that I get angry easily.
3
Please specify your level of agreement: People know that I get angry easily.
4
Please specify your level of agreement: People know that I get angry easily.
5
In the past 7 days, I was resentful when I didn't get my way.
1
In the past 7 days, I was resentful when I didn't get my way.
2
In the past 7 days, I was resentful when I didn't get my way.
3
In the past 7 days, I was resentful when I didn't get my way.
4
In the past 7 days, I was resentful when I didn't get my way.
5
In the past 7 days, I was resentful when I didn't get my way.
6
Please specify your level of agreement: I can't stop myself from doing the same th 1
Please specify your level of agreement: I can't stop myself from doing the same th 2
Please specify your level of agreement: I can't stop myself from doing the same th 3
Please specify your level of agreement: I can't stop myself from doing the same th 4
Please specify your level of agreement: I can't stop myself from doing the same th 5
In the past 7 days, I threatened violence toward people or property.
1
In the past 7 days, I threatened violence toward people or property.
2
In the past 7 days, I threatened violence toward people or property.
3
In the past 7 days, I threatened violence toward people or property.
4
In the past 7 days, I threatened violence toward people or property.
5
In the past 7 days, I threatened violence toward people or property.
6
In the past 7 days, I tried to get even when I was angry at someone.
1
In the past 7 days, I tried to get even when I was angry at someone.
2
In the past 7 days, I tried to get even when I was angry at someone.
3
In the past 7 days, I tried to get even when I was angry at someone.
4
In the past 7 days, I tried to get even when I was angry at someone.
5
In the past 7 days, I tried to get even when I was angry at someone.
6
In the past 7 days, I held grudges toward others.
1
In the past 7 days, I held grudges toward others.
2
In the past 7 days, I held grudges toward others.
3
In the past 7 days, I held grudges toward others.
4
In the past 7 days, I held grudges toward others.
5
In the past 7 days, I held grudges toward others.
6
In the past 7 days, I had trouble controlling my temper.
1
In the past 7 days, I had trouble controlling my temper.
2
In the past 7 days, I had trouble controlling my temper.
3
In the past 7 days, I had trouble controlling my temper.
4
In the past 7 days, I had trouble controlling my temper.
5
In the past 7 days, I had trouble controlling my temper.
6
In the past 7 days, people told me that I talked in a loud or excessive manner.
1
In the past 7 days, people told me that I talked in a loud or excessive manner.
2
In the past 7 days, people told me that I talked in a loud or excessive manner.
3
In the past 7 days, people told me that I talked in a loud or excessive manner.
4
In the past 7 days, people told me that I talked in a loud or excessive manner.
5
In the past 7 days, people told me that I talked in a loud or excessive manner.
6
In the past 7 days, I said or did things that other people probably thought were ina1
In the past 7 days, I said or did things that other people probably thought were ina2
In the past 7 days, I said or did things that other people probably thought were ina3
In the past 7 days, I said or did things that other people probably thought were ina4
In the past 7 days, I said or did things that other people probably thought were ina5
In the past 7 days, I said or did things that other people probably thought were ina6
In the past 7 days, I looked forward with enjoyment to upcoming events.
1
In the past 7 days, I looked forward with enjoyment to upcoming events.
2
In the past 7 days, I looked forward with enjoyment to upcoming events.
3
In the past 7 days, I looked forward with enjoyment to upcoming events.
4
In the past 7 days, I looked forward with enjoyment to upcoming events.
5
In the past 7 days, I looked forward with enjoyment to upcoming events.
6

Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Strongly agree
Agree
Disagree
Strongly disagree
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know
Never
Rarely
Sometimes
Often
Always
I don't know