PedsQL Child Quality of Life Diagnostic Test - the question form
Questions: 23 · 5 minutes
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1. It was hard for me to walk more than one block.
1 - Never
2 - Almost never
3 - Sometimes
4 - Often
5 - Almost always
2. It is hard for me to run.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
3. It was hard for me to play sports or exercise.
1 - Never
2 - Almost never
3 - Sometimes
4 - Often
5 - Almost always
4. It was hard for me to lift heavy objects.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
5. It was hard for me to take a bath or shower by myself.
Never
Almost never
Sometimes
Often
Almost always
6. It was hard for me to do chores around the house.
1 - Never
2 - Almost never
3 - Sometimes
4 - Often
5 - Almost always
7. I hurt or ache.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
8. I felt low on energy.
Never
Almost never
Sometimes
Often
Almost always
9. I felt afraid.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
10. I felt sad.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
11. I felt angry about something.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
12. I had trouble sleeping.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
13. I worried about what might happen to me.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
14. It is hard for me to communicate with peers.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
15. Other kids did not want to be friends with me.
Never
Almost never
Sometimes
Often
Almost always
16. Other kids teased me.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
17. Not able to do things that other children my age can do.
Never
Almost never
Sometimes
Often
Almost always
18. It was hard for me to keep up with my peers.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
19. It was hard for me to pay attention in class.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
20. I forgot things.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
21. It was hard for me to keep up with my schoolwork.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
22. I missed school because I was not feeling well.
Never
Almost never
Sometimes
Often
Almost always
23. I missed school because I had to go to the doctor or the hospital.
Never
Almost never
Sometimes
Often
Almost always
1. It was hard for me to walk more than one bus stop.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
2. It is hard for me to run.
1 - Never
2 - Almost never
3 - Sometimes
4 - Often
5 - Almost always
3. It has been hard for me to play sports or exercise.
Never
Almost never
Sometimes
Often
Almost always
4. It was hard for me to lift heavy objects.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
5. It has been hard for me to take a bath or shower by myself.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
6. It was hard for me to do chores around the home.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
7. I hurt or ached.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
8. I had low energy.
1 - Never
2 - Almost never
3 - Sometimes
4 - Often
5 - Almost always
9. I felt afraid.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
10. I felt sad.
1 - Never
2 - Almost never
3 - Sometimes
4 - Often
5 - Almost always
11. I felt angry.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
12. I had trouble sleeping.
1 - Never
2 - Almost never
3 - Sometimes
4 - Often
5 - Almost always
13. I worried about what might happen to me.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
14. It was hard for me to get along with other kids.
Never
Almost never
Sometimes
Often
Almost always
15. Other kids did not want to be friends with me.
Never
Almost never
Sometimes
Often
Almost always
16. Other kids teased me.
Never
Almost never
Sometimes
Often
Almost always
17. I had trouble doing the same things as other kids my age.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
18. It was hard for me to keep up with my peers.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
19. It was hard for me to pay attention in class.
Never
Almost never
Sometimes
Often
Almost always
20. I was forgetful.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
21. It was hard for me to keep up with my schoolwork.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
22. I missed school because I did not feel well.
1 – Never
2 – Almost never
3 – Sometimes
4 – Often
5 – Almost always
23. I missed school because I had to go to the doctor or the hospital.
Never
Almost never
Sometimes
Often
Almost always