Note: Think of one child when completing the following questionnaire.
1. My child asks me for help.
Never









Frequently
2. My child shares his/her goals and interests with me.
Never









Frequently
3. My child talks with me when hurting (physically or emotionally).
Never









Frequently
4. My child tells me about his/her friends?
Never









Frequently
5. When receiving correction, my child is receptive and teachable.
Never









Frequently
6. My child welcomes my affection.
Never









Frequently
7. My child participates in family activities.
Never









Frequently
8. My child comes to me when he/she has done something wrong.
Never









Frequently
9. My child shares his/her struggles with me.
Never









Frequently
10. My child is interested in my opinion.
Never









Frequently
11. My child and I enjoy a hobby or activity together.
Never









Frequently
12. My child informs me when his/her plans change.
Never









Frequently

Your score:

Scoring the Parental Influence Questionnaire

This survey is based on the following:

Your ability to help things go right for your child is determined by how often you connect with your child and openly share concerns, struggles, and successes with one another.

> 84

If your score is greater than 84, chances are you are connecting with your child frequently and are having a great deal of positive influence in your child’s life. Continue to find ways to spend quality and frequent time with your child.

60-84

If your score is between 60 and 84, spend less time correcting and focus on finding ways to increase the frequency and the quality of the time you spend with you child.

48-59

If your score is between 48 and 59, spend less time correcting and focus on finding ways to increase the frequency and the quality of the time you spend with your child—and ask for help. Invite your child’s favorite coach, teacher, relative, or neighbor to spend frequent, quality time with your child.

< 48

If your score is less than 48, seek an outside intervention for you and your child (i.e., counseling, groups, and/or treatment program—depending upon the degree of at-risk choices your child is making) to help heal and strengthen the parent-child relationship.

Note: Take this survey again in 60 days to see if you have made any improvement.

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